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Prognostic Value of Tpeak-Tend Interval in Early Diagnosis of Duchenne Muscular Dystrophy Cardiomyopathy
Serra Baskan1, Pelin Karaca Ozer2, Huseyin Orta2
1Department of Pediatric Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34134, Turkey.
Insights
The Tpeak-Tend interval, a measurement from ECGs, can help detect cardiac issues and early arrhythmia risk in Duchenne muscular dystrophy (DMD) patients. Prolonged Tpeak-Tend intervals predict a higher burden of premature ventricular contractions, indicating significant cardiac involvement.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Genetics
Background:
- Cardiomyopathy is the leading cause of mortality in Duchenne muscular dystrophy (DMD).
- Early identification of cardiac involvement and arrhythmic risk is crucial for managing DMD patients.
- The Tpeak-Tend (Tp-e) interval is a novel electrocardiographic marker that may reflect ventricular repolarization abnormalities.
Purpose of the Study:
- To investigate the association between the Tp-e interval and the burden of premature ventricular contractions (PVCs) in DMD patients.
- To assess the utility of the Tp-e interval in predicting early arrhythmic risk and cardiac involvement in DMD.
- To compare Tp-e intervals and other cardiac markers between DMD patient groups with varying PVC frequencies and healthy controls.
Main Methods:
- A study involving 25 DMD patients, categorized into two groups based on 24-hour Holter monitoring for PVC frequency (<1% vs. >1%).
- Comparison of electrocardiographic (ECG) parameters, including the Tp-e interval, and biochemical markers (Pro-BNP, troponin) with a control group of 27 healthy individuals.
- Statistical analysis, including logistic regression, to identify independent predictors of high PVC burden and to evaluate the diagnostic performance of the Tp-e interval.
Main Results:
- Patients with >1% PVCs (Group 2) exhibited lower left ventricular ejection fraction (LVEF) and larger LV end-diastolic diameter compared to Group 1 and controls.
- Elevated Pro-BNP and troponin levels were observed in both DMD groups compared to controls.
- A significantly longer Tp-e interval was found in Group 2 compared to Group 1 and controls.
- Both LVEF and Tp-e interval were identified as independent predictors of PVC frequency >1% in DMD patients.
- A Tp-e interval exceeding 71.65 ms demonstrated high sensitivity (80%) and specificity (90%) for predicting >1% PVCs.
Conclusions:
- Prolongation of the Tp-e interval is associated with a higher burden of PVCs and may serve as an indicator of cardiac involvement in DMD.
- The Tp-e interval, easily measurable from ECGs, can aid in the early diagnosis of arrhythmic risk in Duchenne muscular dystrophy patients.
- Utilizing Tp-e interval measurements could enhance the monitoring and management strategies for cardiac complications in DMD.
Abstract:
The most common cause of death in patients with Duchenne muscular dystrophy (DMD) is cardiomyopathy. Our aim was to investigate the relationship between the Tpeak-Tend (Tp-e) interval and the premature ventricular contraction (PVC) burden and therefore early arrhythmic risk and cardiac involvement in DMD patients. Twenty-five patients with DMD followed by pediatric cardiology were included in the study. Those with a frequency of <1% PVC in the 24 h Holter were assigned to Group 1 (n = 15), and those with >1% were assigned to Group 2 (n = 10). Comparisons were made with healthy controls (n = 27). Left ventricular ejection fraction (LVEF) was lowest in Group 2 and highest in the control group (p < 0.001). LV end-diastolic diameter was greater in Group 2 than in Group 1 and the control group (p = 0.005). Pro-BNP and troponin levels were higher in Group 1 and Group 2 than in the control group (p = 0.001 and p < 0.001, respectively). Tp-e interval was longer in Group 2 compared to Group 1 and the control group (p < 0.001). The LVEF (OR 0.879, 95% CI 0.812-0.953; p = 0.002) and Tp-e interval (OR 1.181, 95% CI 1.047-1.332; p = 0.007) were independent predictors of PVC/24 h frequency of >1%. A Tp-e interval > 71.65 ms predicts PVC > 1%, with a sensitivity of 80% and a specificity of 90% (AUC = 0.842, 95% CI (0.663-1.000), p = 0.001). Determination of Tp-e prolongation from ECG data may help in the determination of cardiac involvement and early diagnosis of arrhythmic risk in DMD.
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