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Evaluation of Tpeak-end interval, Tpeak-end/QT, and Tpeak-end/Qtc ratio during acute migraine attack in the emergency department

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Abstract

Introduction

During an acute migraine attack, changes in ventricular repolarisation parameters may occur due to an imbalance in the autonomic nervous system. Tpeak-tend (Tp-e) interval, Tp-e/QT ratio, and Tp-e/corrected QT (QTc) ratio are novel parameters of arrhythmogenesis and can be easily calculated in electrocardiography (ECG). The objective of this study is to demonstrate that novel ventricular repolarisation parameters can anticipate the risk of ventricular dysrhythmia in the migraine attack period.

Methods

This research was a prospective case–control study, which recruited a total of 144 participants, including 74 migraine patients and 70 healthy volunteers in the control group (CG) who met the criteria for migraine with or without aura. All participants underwent 12-lead ECG recordings, and the study compared the Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio with those of the CG.

Results

The average age of patients experiencing migraine attacks was 38.14 ± 10.82, with 58 (76%) of these patients being female. The Tp-e interval mean was higher in the migraine attack group than the CG, with a statistically significant difference discovered (74.22 ± 20.20 ms [ms] compared to 65.39 ± 11.33 ms, p = 0.001). However, there were higher mean Tp-e/QT and Tp-e/QTc ratios in the migraine attack group compared to the CG, and this difference was found to be statistically significant (0.20 ± 0.05 vs. 0.17 ± 0.03, p = 0.001, 0.18 ± 0.52 vs 0.16 ± 0.29, p = 0.003, respectively).

Conclusion

Prolonged Tp-e interval and elevated Tp-e/QT and Tp-e/QTc ratios were observed in migraine patients who presented to the emergency department, indicating a potential risk of ventricular dysrhythmia.

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References

  1. Shi M, Luo D, Guo J, Yang D, Li Z, Zhao H (2022) The function of the autonomic nervous system in Asian patients with chronic migraine. Front Neurosci 16:773321. https://doi.org/10.3389/fnins.2022.773321

    Article  PubMed  PubMed Central  Google Scholar 

  2. Aygun D, Altintop L, Doganay Z, Guven H, Baydin A (2003) Electrocardiographic changes during migraine attacks. Headache 43:861–866. https://doi.org/10.1046/j.1526-4610.2003.03164.x

    Article  CAS  PubMed  Google Scholar 

  3. Duru M, Melek I, Seyfeli E et al (2006) QTc dispersion and P-wave dispersion during migraine attacks. Cephalalgia 6:672–677

    Article  Google Scholar 

  4. Aygun D, Altintop L, Doganay Z, Guven H, Baydin A (2003) Electrocardiographic changes during migraine attacks. Headache J Head Face Pain 43(8):861–866

    Article  CAS  Google Scholar 

  5. Páll A, Sebestyén V, Czifra A et al (2017) The disparate effect of hemodialysis and hemodiafiltration on T-wave-peak-to-end interval (Tpe) and Tpe/QT ratio of the surface electrocardiogram. Trauma Emerg Care 2:1–6. https://doi.org/10.15761/TEC.1000142

    Article  Google Scholar 

  6. Imran TF, Rahman I, Dikdan S et al (2016) QT prolongation and clinical outcomes in patients with takotsubo cardiomyopathy. Pacing Clin Electrophysiol 39:607–611. https://doi.org/10.1111/pace.12864

    Article  PubMed  Google Scholar 

  7. Gopalakrishnan M, Hassan A, Villines D, Nasr S, Chandrasekaran M, Klein LW (2015) Predictors of short-and long-term outcomes of Takotsubo cardiomyopathy. Am J Cardiol 116:1586–1590. https://doi.org/10.1016/j.amjcard.2015.08.024

    Article  PubMed  Google Scholar 

  8. Lux RL (2017) Basis and ECG measurement of global ventricular repolarization. J Electrocardiol 50:792–797. https://doi.org/10.1016/j.jelectrocard.2017.07.008

    Article  PubMed  Google Scholar 

  9. Akilli NB, Akinci E, Akilli H et al (2013) A new marker for myocardial injury in carbon monoxide poisoning: T peak–T end. Am J Emerg Med 31:1651–1655. https://doi.org/10.1016/j.ajem.2013.08.049

    Article  PubMed  Google Scholar 

  10. Xia Y, Liang Y, Kongstad O et al (2005) In vivo validation of the coincidence of the peak and end of the T wave with full repolarization of the epicardium and endocardium in swine. Heart Rhythm 2:162–169. https://doi.org/10.1016/j.hrthm.2004.11.011

    Article  PubMed  Google Scholar 

  11. Opthof T, Coronel R, Wilms-Schopman FJ et al (2007) Dispersion of repolarization in canine ventricle and the electrocardiographic T wave: Tp-e interval does not reflect transmural dispersion. Heart Rhythm 4:341–348. https://doi.org/10.1016/j.hrthm.2006.11.022

    Article  PubMed  Google Scholar 

  12. Tanriverdi Z, Besli F, Gungoren F (2018) The evaluation of Tp-e interval after transcatheter aortic valve implantation. J Electrocardiol 51:573. https://doi.org/10.1016/j.jelectrocard.2018.03.015

    Article  PubMed  Google Scholar 

  13. Coşkun FY, Elboğa G, Altunbaş G, Vuruşkan E, Uğur BK, Sucu M (2018) Evaluation of ventricular repolarization features with Tp-e, Tp-e/QTc, JTc and JTd during electroconvulsive therapy. J Electrocardiol 51:440–442. https://doi.org/10.1016/j.jelectrocard.2018.02.003

    Article  Google Scholar 

  14. Monroe DJ, Meehan JT IV, Schandl CA (2015) Sudden cardiac death in a young man with migraine-associated arrhythmia. J Forensic Sci 60:1633–1636. https://doi.org/10.1111/1556-4029.12836

    Article  PubMed  Google Scholar 

  15. Pitarokoili K, Dahlhaus S, Hellwig K et al (2013) Ventricular tachycardia during basilar-type migraine attack. Ther Adv Neurol Disord 6:35–40. https://doi.org/10.1177/1756285612463625

    Article  PubMed  PubMed Central  Google Scholar 

  16. Arnold M (2018) Headache classification committee of the international headache society (IHS) the international classification of headache disorders. Cephalalgia 38:1–211. https://doi.org/10.1177/0333102417738202

    Article  Google Scholar 

  17. Franciosi S, Perry FKG, Roston TM, Armstrong KR, Claydon VE, Sanatani S (2017) The role of the autonomic nervous system in arrhythmias and sudden cardiac death. Auton Neurosci 205:1–11. https://doi.org/10.1016/j.autneu.2017.03.005

    Article  PubMed  Google Scholar 

  18. Shusterman V, Aysin B, Gottipaty V et al (1998) Autonomic nervous system activity and the spontaneous initiation of ventricular tachycardia. J Am Coll Cardiol 32:1891–1899. https://doi.org/10.1016/s0735-1097(98)00468-9

    Article  CAS  PubMed  Google Scholar 

  19. Shapiro RE, Hochstetler HM, Dennehy EB et al (2019) Lasmiditan for acute treatment of migraine in patients with cardiovascular risk factors: post-hoc analysis of pooled results from 2 randomized, double-blind, placebo-controlled, phase 3 trials. J Headache Pain 20:1–10. https://doi.org/10.1186/s10194-019-1044-6

    Article  CAS  Google Scholar 

  20. Pogacnik T, Sega S, Pecnik B, Kiauta T (1993) Autonomic function testing in patients with migraine. Headache 33:545–550. https://doi.org/10.1111/j.1526-4610.1993.hed3310545.x

    Article  CAS  PubMed  Google Scholar 

  21. Shechter A, Stewart WF, Silberstein SD, Lipton RB (2002) Migraine and autonomic nervous system function: a population-based, case-control study. Neurology 58:422–427. https://doi.org/10.1212/wnl.58.3.422

    Article  PubMed  Google Scholar 

  22. Appel S, Kuritzky A, Zahavi I, Zigelman M, Akselrod S (1992) Evidence for instability of the autonomic nervous system in patients with migraine headache. Headache 32:10–17. https://doi.org/10.1111/j.1526-4610.1992.hed3201010.x. (Erratum in: Headache 1992 Apr;32(4):174)

    Article  CAS  PubMed  Google Scholar 

  23. Shimizu H, Ohnishi Y, Inoue T, Yokoyama M (2001) QT and JT dispersion in patients with monomorphic or polymorphic ventricular tachycardia/ventricular fibrillation. J Electrocardiol 34:119–125. https://doi.org/10.1054/jelc.2001.23361

    Article  CAS  PubMed  Google Scholar 

  24. Tse G, Gong M, Wong WT et al (2017) The Tpeak−Tend interval as an electrocardiographic risk marker of arrhythmic and mortality outcomes: a systematic review and meta-analysis. Heart Rhythm 14:1131–1137. https://doi.org/10.1016/j.hrthm.2017.05.031

    Article  PubMed  Google Scholar 

  25. Panikkath R, Reinier K, Uy-Evanado A et al (2011) Prolonged Tpeak-to-tend interval on the resting ECG is associated with increased risk of sudden cardiac death. Circ Arrhythm Electrophysiol 4:441–447

    Article  PubMed  PubMed Central  Google Scholar 

  26. Bachmann TN, Skov MW, Rasmussen PV et al (2016) Electrocardiographic Tpeak–Tend interval and risk of cardiovascular morbidity and mortality: results from the Copenhagen ECG study. Heart Rhythm 13:915–924. https://doi.org/10.1016/j.hrthm.2015.12.027

    Article  PubMed  Google Scholar 

  27. Braschi A, Frasheri A, Lombardo RM et al (2021) Association between Tpeak–Tend/QT and major adverse cardiovascular events in patients with Takotsubo syndrome. Acta Cardiol 76:732–738. https://doi.org/10.1080/00015385.2020.1776012

    Article  PubMed  Google Scholar 

  28. Akboğa MK, Gülcihan Balcı K, Yılmaz S et al (2017) Tp-e interval and Tp-e/QTc ratio as novel surrogate markers for prediction of ventricular arrhythmic events in hypertrophic cardiomyopathy. Anatol J Cardiol 18:48–53. https://doi.org/10.14744/AnatolJCardiol.2017.7581

    Article  PubMed  PubMed Central  Google Scholar 

  29. Avcı A, Biricik S, Avcı BŞ et al (2022) QTc, Tp-e interval and Tp-e/QTc ratio changes in hypoxia due to hypertensive pulmonary edema-case control study. Eurasian J Emerg Med. 21(1):14–19. https://doi.org/10.4274/eajem.galenos.2020.82712

    Article  Google Scholar 

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  1. Antalya Training and Research Hospital: Antalya Egitim ve Arastirma Hastanesi, Antalya, Turkey

    Fatih Selvi, Mustafa Korkut, Cihan Bedel, Görkem Kuş & Ökkeş Zortuk

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  1. Fatih Selvi
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Selvi, F., Korkut, M., Bedel, C. et al. Evaluation of Tpeak-end interval, Tpeak-end/QT, and Tpeak-end/Qtc ratio during acute migraine attack in the emergency department. Acta Neurol Belg (2024). https://doi.org/10.1007/s13760-024-02497-x

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