Skip to main content
Erschienen in: Pediatric Cardiology 8/2014

01.12.2014 | Original Article

Increased P-Wave and QT Dispersions Necessitate Long-Term Follow-up Evaluation of Down Syndrome Patients With Congenitally Normal Hearts

verfasst von: Cem Karadeniz, Rahmi Ozdemir, Fikri Demir, Yılmaz Yozgat, Mehmet Küçük, Talia Oner, Utku Karaarslan, Timur Meşe, Nurettin Unal

Erschienen in: Pediatric Cardiology | Ausgabe 8/2014

Einloggen, um Zugang zu erhalten

Abstract

Reports state that Down syndrome (DS) patients with congenitally normal hearts might experience the development of cardiac abnormalities such as cardiac autonomic dysfunction, valvular lesions, bradycardia, and atrioventricular block. However, the presence of any difference in terms of P-wave dispersion (PWd) and QT dispersion (QTd) was not evaluated previously. This study prospectively investigated 100 DS patients with structurally normal hearts and 100 age- and sex-matched healthy control subjects. Standard 12-lead electrocardiograms were used to assess and compare P-wave and QT durations together with PWd and QTd. The median age of the DS patients and control subjects was 48 months. Heart rates and P-wave and QT dispersions were significantly greater in the DS group than in the control group (113 ± 22.9 vs 98.8 ± 16.6 bpm, p < 0.001; 31.3 ± 9.5 vs 24 ± 8.6 ms, p < 0.001; and 46.6 ± 15.9 vs 26 ± 9.1 ms, p < 0.001, respectively). A positive correlation was found between PWd and age in the DS patients (p < 0.05; r = 0.2). All children with DS should be followed up carefully with electrocardiography in terms of increased P-wave and QT dispersions even in the absence of concomitant congenital heart disease for management of susceptibility to arryhthmias.
Literatur
1.
Zurück zum Zitat Agiovlasitis S, Collier SR, Baynard T, Echols GH, Goulopoulou S, Figueroa A et al (2010) Autonomic response to upright tilt in people with and without Down syndrome. Res Dev Disabil 31:857–863CrossRefPubMed Agiovlasitis S, Collier SR, Baynard T, Echols GH, Goulopoulou S, Figueroa A et al (2010) Autonomic response to upright tilt in people with and without Down syndrome. Res Dev Disabil 31:857–863CrossRefPubMed
2.
Zurück zum Zitat Agiovlasitis S, Baynard T, Pitetti KH, Fernhall B (2011) Heart rate complexity in response to upright tilt in persons with Down syndrome. Res Dev Disabil 32:2102–2107CrossRefPubMed Agiovlasitis S, Baynard T, Pitetti KH, Fernhall B (2011) Heart rate complexity in response to upright tilt in persons with Down syndrome. Res Dev Disabil 32:2102–2107CrossRefPubMed
3.
Zurück zum Zitat Baynard T, Guerra M, Pitetti KH, Fernhall B (2004) Heart rate variability at rest and exercise in persons with Down syndrome. Arch Phys Med Rehabil 85:1285–1290CrossRefPubMed Baynard T, Guerra M, Pitetti KH, Fernhall B (2004) Heart rate variability at rest and exercise in persons with Down syndrome. Arch Phys Med Rehabil 85:1285–1290CrossRefPubMed
4.
Zurück zum Zitat Bazett HC (1920) An analysis of the time relations of electrocardiograms. Heart 7:353–370 Bazett HC (1920) An analysis of the time relations of electrocardiograms. Heart 7:353–370
5.
Zurück zum Zitat Bissinger A, Grycewicz T, Grabowicz W, Lubinski A (2011) The effect of diabetic autonomic neuropathy on P-wave duration, dispersion, and atrial fibrillation. Arch Med Sci 7:806–812PubMedCentralCrossRefPubMed Bissinger A, Grycewicz T, Grabowicz W, Lubinski A (2011) The effect of diabetic autonomic neuropathy on P-wave duration, dispersion, and atrial fibrillation. Arch Med Sci 7:806–812PubMedCentralCrossRefPubMed
6.
Zurück zum Zitat Bittles AH, Bower C, Hussain R, Glasson EJ (2007) The four ages of Down syndrome. Eur J Public Health 17:221–225CrossRefPubMed Bittles AH, Bower C, Hussain R, Glasson EJ (2007) The four ages of Down syndrome. Eur J Public Health 17:221–225CrossRefPubMed
7.
Zurück zum Zitat Blom NA, Ottenkamp J, Deruiter MC, Wenink ACG, Gittenberger-De Groot AC (2005) Development of the cardiac conduction system in atrioventricular septal defect in human trisomy 21. Pediatr Res 58:516–520CrossRefPubMed Blom NA, Ottenkamp J, Deruiter MC, Wenink ACG, Gittenberger-De Groot AC (2005) Development of the cardiac conduction system in atrioventricular septal defect in human trisomy 21. Pediatr Res 58:516–520CrossRefPubMed
8.
Zurück zum Zitat Bluzaite I, Brazdzionyte J, Zaliunas R, Rickli H, Ammann P (2006) QT dispersion and heart rate variability in sudden death risk stratification in patients with ischemic heart disease. Medicina Kaunas 42:450–454PubMed Bluzaite I, Brazdzionyte J, Zaliunas R, Rickli H, Ammann P (2006) QT dispersion and heart rate variability in sudden death risk stratification in patients with ischemic heart disease. Medicina Kaunas 42:450–454PubMed
9.
Zurück zum Zitat Bricout VA, Guinot M, Faure P, Flore P, Eberhard Y, Garnier P et al (2008) Are hormonal responses to exercise in young men with Down’s syndrome related to reduced endurance performance? J Neuroendocrinol 20:558–565CrossRefPubMed Bricout VA, Guinot M, Faure P, Flore P, Eberhard Y, Garnier P et al (2008) Are hormonal responses to exercise in young men with Down’s syndrome related to reduced endurance performance? J Neuroendocrinol 20:558–565CrossRefPubMed
10.
Zurück zum Zitat Das BB, Sharma J (2004) Repolarization abnormalities in children with a structurally normal heart and ventricular ectopy. Pediatr Cardiol 25:354–356PubMed Das BB, Sharma J (2004) Repolarization abnormalities in children with a structurally normal heart and ventricular ectopy. Pediatr Cardiol 25:354–356PubMed
11.
Zurück zum Zitat de Simone G, Daniels SR, Devereux RB, Meyer RA, Roman MJ, de Divitiis O et al (1992) Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol 20:1251–1260CrossRefPubMed de Simone G, Daniels SR, Devereux RB, Meyer RA, Roman MJ, de Divitiis O et al (1992) Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol 20:1251–1260CrossRefPubMed
12.
Zurück zum Zitat Dilaveris PE, Gialafos EJ, Sideris SK, Theopistou AM, Andrikopoulos GK, Kyriakidis M et al (1998) Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J 135:733–738CrossRefPubMed Dilaveris PE, Gialafos EJ, Sideris SK, Theopistou AM, Andrikopoulos GK, Kyriakidis M et al (1998) Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J 135:733–738CrossRefPubMed
13.
Zurück zum Zitat Esbensen AJ, Seltzer MM, Greenberg JS (2007) Factors predicting mortality in midlife adults with and without Down syndrome living with family. J Intellect Disabil Res 51:1039–1050CrossRefPubMed Esbensen AJ, Seltzer MM, Greenberg JS (2007) Factors predicting mortality in midlife adults with and without Down syndrome living with family. J Intellect Disabil Res 51:1039–1050CrossRefPubMed
14.
Zurück zum Zitat Fernhall B, Otterstetter M (2003) Attenuated responses to sympathoexcitation in individuals with Down syndrome. J Appl Physiol 94:2158–2165CrossRefPubMed Fernhall B, Otterstetter M (2003) Attenuated responses to sympathoexcitation in individuals with Down syndrome. J Appl Physiol 94:2158–2165CrossRefPubMed
15.
Zurück zum Zitat Fernhall B, Renaud M, Holden H, Slotter C (2000) Autonomic control during exercise is altered in Down syndrome. Sci Sports 15:288 Fernhall B, Renaud M, Holden H, Slotter C (2000) Autonomic control during exercise is altered in Down syndrome. Sci Sports 15:288
16.
Zurück zum Zitat Fernhall B, Baynard T, Collier SR, Figueroa A, Goulopoulou S, Kamimori G et al (2009) Catecholamine response to maximal exercise in persons with Down syndrome. Am J Cardiol 103:724–726CrossRefPubMed Fernhall B, Baynard T, Collier SR, Figueroa A, Goulopoulou S, Kamimori G et al (2009) Catecholamine response to maximal exercise in persons with Down syndrome. Am J Cardiol 103:724–726CrossRefPubMed
17.
Zurück zum Zitat Goldsmith RL, Bloomfield DM, Rosenwinkel ET (2000) Exercise and autonomic function. Coron Artery Dis 11:129–135CrossRefPubMed Goldsmith RL, Bloomfield DM, Rosenwinkel ET (2000) Exercise and autonomic function. Coron Artery Dis 11:129–135CrossRefPubMed
18.
Zurück zum Zitat Gorlin RJ, Cohen MM, Hennekam RCM (2001) Syndromes of the head and neck, 4th edn. Oxford University Press, Oxford, pp 35–76 Gorlin RJ, Cohen MM, Hennekam RCM (2001) Syndromes of the head and neck, 4th edn. Oxford University Press, Oxford, pp 35–76
19.
Zurück zum Zitat Guerra M, Llorens N, Fernhall B (2003) Chronotropic incompetence in persons with Down syndrome. Arch Phys Med Rehabil 84:1604–1608CrossRefPubMed Guerra M, Llorens N, Fernhall B (2003) Chronotropic incompetence in persons with Down syndrome. Arch Phys Med Rehabil 84:1604–1608CrossRefPubMed
20.
Zurück zum Zitat Hamada T, Gejyo F, Koshino Y, Murata T, Omori M, Nishio M et al (1998) Echocardiographic evaluation of cardiac valvular abnormalities in adults with Down’s syndrome. Tohoku J Exp Med 185:31–35CrossRefPubMed Hamada T, Gejyo F, Koshino Y, Murata T, Omori M, Nishio M et al (1998) Echocardiographic evaluation of cardiac valvular abnormalities in adults with Down’s syndrome. Tohoku J Exp Med 185:31–35CrossRefPubMed
21.
Zurück zum Zitat Hayes C, Johnson Z, Thornton L, Fogarty J, Lyons R, O’Connor M et al (1997) Ten-year survival of Down syndrome births. Int J Epidemiol 26:822–829CrossRefPubMed Hayes C, Johnson Z, Thornton L, Fogarty J, Lyons R, O’Connor M et al (1997) Ten-year survival of Down syndrome births. Int J Epidemiol 26:822–829CrossRefPubMed
22.
Zurück zum Zitat Iellamo F, Galante A, Legramante JM, Lippi ME, Condoluci C, Albertini G et al (2005) Altered autonomic cardiac regulation in individuals with Down syndrome. Am J Physiol Heart Circ Physiol 289:2387–2391CrossRef Iellamo F, Galante A, Legramante JM, Lippi ME, Condoluci C, Albertini G et al (2005) Altered autonomic cardiac regulation in individuals with Down syndrome. Am J Physiol Heart Circ Physiol 289:2387–2391CrossRef
23.
Zurück zum Zitat Karadeniz C, Ozdemir R, Yozgat Y, Mese T (2013) An unexpected aortic valve in trisomy 21. Am J Med Genet Part A 161:2670–2671 Karadeniz C, Ozdemir R, Yozgat Y, Mese T (2013) An unexpected aortic valve in trisomy 21. Am J Med Genet Part A 161:2670–2671
24.
Zurück zum Zitat Kistler PM, Sanders P, Fynn SP, Stevenson IH, Spence SJ, Vohra JK et al (2004) Electrophysiologic and electroanatomic changes in the human atrium associated with age. J Am Coll Cardiol 44:109–116CrossRefPubMed Kistler PM, Sanders P, Fynn SP, Stevenson IH, Spence SJ, Vohra JK et al (2004) Electrophysiologic and electroanatomic changes in the human atrium associated with age. J Am Coll Cardiol 44:109–116CrossRefPubMed
25.
Zurück zum Zitat Migliaro E, Contreras P, Bech S, Etxagibel A, Castro M, Ricca R et al (2001) Relative influence of age, resting heart rate, and sedentary lifestyle in short-term analysis of heart rate variability. Braz J Med Biol Res 34:493–500CrossRefPubMed Migliaro E, Contreras P, Bech S, Etxagibel A, Castro M, Ricca R et al (2001) Relative influence of age, resting heart rate, and sedentary lifestyle in short-term analysis of heart rate variability. Braz J Med Biol Res 34:493–500CrossRefPubMed
26.
Zurück zum Zitat Nakagawa M, Takahashi N, Iwao T, Yonemochi H, Ooie T, Hara M et al (1999) Evaluation of autonomic influences on QT dispersion using the head-up tilt test in healthy subjects. Pacing Clin Electrophysiol 22:1158–1163CrossRefPubMed Nakagawa M, Takahashi N, Iwao T, Yonemochi H, Ooie T, Hara M et al (1999) Evaluation of autonomic influences on QT dispersion using the head-up tilt test in healthy subjects. Pacing Clin Electrophysiol 22:1158–1163CrossRefPubMed
27.
Zurück zum Zitat Ozer N, Aytemir K, Atalar E, Sade E, Aksöyek S, Ovünç K et al (2000) P-wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 23:1109–1112CrossRefPubMed Ozer N, Aytemir K, Atalar E, Sade E, Aksöyek S, Ovünç K et al (2000) P-wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 23:1109–1112CrossRefPubMed
28.
Zurück zum Zitat Pye M, Quinn AC, Cobbe SM (1994) QT interval dispersion: a noninvasive marker of susceptibility to arrhythmia in patients with sustained ventricular arrhythmias? Br Heart J 71:511–514PubMedCentralCrossRefPubMed Pye M, Quinn AC, Cobbe SM (1994) QT interval dispersion: a noninvasive marker of susceptibility to arrhythmia in patients with sustained ventricular arrhythmias? Br Heart J 71:511–514PubMedCentralCrossRefPubMed
29.
Zurück zum Zitat Raveau M, Lignon JM, Nalesso V, Duchon A, Groner Y, Sharp AJ et al (2012) The App-Runx1 region ıs critical for birth defects and electrocardiographic dysfunctions observed in a Down syndrome mouse model. PLoS Genet 8:e1002724PubMedCentralCrossRefPubMed Raveau M, Lignon JM, Nalesso V, Duchon A, Groner Y, Sharp AJ et al (2012) The App-Runx1 region ıs critical for birth defects and electrocardiographic dysfunctions observed in a Down syndrome mouse model. PLoS Genet 8:e1002724PubMedCentralCrossRefPubMed
31.
Zurück zum Zitat Sap F, Karataş Z, Altin H, Alp H, Oran B, Baysal T et al (2013) Dispersion durations of P-wave and QT interval in children with congenital heart disease and pulmonary arterial hypertension. Pediatr Cardiol 34:591–596CrossRefPubMed Sap F, Karataş Z, Altin H, Alp H, Oran B, Baysal T et al (2013) Dispersion durations of P-wave and QT interval in children with congenital heart disease and pulmonary arterial hypertension. Pediatr Cardiol 34:591–596CrossRefPubMed
32.
Zurück zum Zitat Seal A, Shinebourne E (2004) Cardiac problems in Down syndrome. Curr Pediatr 14:33–38CrossRef Seal A, Shinebourne E (2004) Cardiac problems in Down syndrome. Curr Pediatr 14:33–38CrossRef
33.
Zurück zum Zitat Stoll C, Alembik Y, Dott B, Roth MP (1998) Study of Down syndrome in 238,942 consecutive births. Ann Genet 41:44–51PubMed Stoll C, Alembik Y, Dott B, Roth MP (1998) Study of Down syndrome in 238,942 consecutive births. Ann Genet 41:44–51PubMed
34.
Zurück zum Zitat Tran H, White CM, Chow MS, Kluger J (2001) An evaluation of the impact of gender and age on QT dispersion in healthy subjects. Ann Noninvasive Electrocardiol 6:129–133CrossRefPubMed Tran H, White CM, Chow MS, Kluger J (2001) An evaluation of the impact of gender and age on QT dispersion in healthy subjects. Ann Noninvasive Electrocardiol 6:129–133CrossRefPubMed
35.
Zurück zum Zitat van der Bom T, Zomer AC, Zwinderman AH, Meijboom FJ, Bouma BJ, Mulder BJ (2011) The changing epidemiology of congenital heart disease. Nat Rev Cardiol 8:50–60CrossRefPubMed van der Bom T, Zomer AC, Zwinderman AH, Meijboom FJ, Bouma BJ, Mulder BJ (2011) The changing epidemiology of congenital heart disease. Nat Rev Cardiol 8:50–60CrossRefPubMed
36.
Zurück zum Zitat Yavuz B, Deveci OS, Yavuz BB, Halil M, Aytemir K, Cankurtaran M et al (2006) QT dispersion increases with aging. Ann Noninvasive Electrocardiol 11:127–131CrossRefPubMed Yavuz B, Deveci OS, Yavuz BB, Halil M, Aytemir K, Cankurtaran M et al (2006) QT dispersion increases with aging. Ann Noninvasive Electrocardiol 11:127–131CrossRefPubMed
Metadaten
Titel
Increased P-Wave and QT Dispersions Necessitate Long-Term Follow-up Evaluation of Down Syndrome Patients With Congenitally Normal Hearts
verfasst von
Cem Karadeniz
Rahmi Ozdemir
Fikri Demir
Yılmaz Yozgat
Mehmet Küçük
Talia Oner
Utku Karaarslan
Timur Meşe
Nurettin Unal
Publikationsdatum
01.12.2014
Verlag
Springer US
Erschienen in
Pediatric Cardiology / Ausgabe 8/2014
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-014-0934-2

Weitere Artikel der Ausgabe 8/2014

Pediatric Cardiology 8/2014 Zur Ausgabe

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.