ABSTRACT
Cite this article as: Acar S, Eminler AT. Could hepatitis B reactivation be overlooked in patients with resolved hepatitis B virus infection and receiving immunosuppressive treatment? Turk J Gastroenterol. 2024;35(4):350-351.
Subject(s)
Hepatitis B virus , Hepatitis B , Immunosuppressive Agents , Virus Activation , Humans , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Virus Activation/drug effects , Hepatitis B virus/immunology , Hepatitis B/drug therapy , Hepatitis B/immunology , Male , Female , Hepatitis B, Chronic/drug therapy , Hepatitis B, Chronic/immunologyABSTRACT
BACKGROUND/AIMS: Pancreatic steatosis (PS) is a pathology associated with metabolic syndrome (MS), endocrin and exocrine disfunctions of the pancreas, and fatty liver. The data on the frequency of PS are very limited. We aimed to evaluate the frequency of PS detected by transabdominal ultrasonography (TAU) in gastroenterology clinics located in different geographical regions of Turkey and the factors associated with it. MATERIALS AND METHODS: Volunteers were evaluated by TAU for PS and hepatosteatosis (HS), and its degree. Pancreatic stiffness was evaluated by ultrasonographic shear wave elastography (SWE). All demographic, physical, and biochemical parametres were measured. RESULTS: A total of 1700 volunteers from 14 centers throughout Turkey were included in the study. Mean age was 48.03 ± 20.86 years (56.9% female). Prevalance of PS was detected in 68.9%. In the PS group, age, body mass index (BMI), waist circumference, systolic blood pressure, fasting blood glucose (FBG), lipid levels, insulin resistance, diabetes mellitus, hypertension, MS frequency, and pancreatic SWE score were increasing, and fecal elastase level was decreasing in correlation with the degree of PS. The frequency of HS was 55.5%. Hepatosteatosis [odds ratio (OR): 9.472], increased age (OR: 1.02), and BMI (OR: 1.089) were independent risk factors for the occurrence of PS. Lean-PS rate was 11.8%. The lean-PS group was predominantly female and younger than non-lean PS. Also it has lower blood pressure, FBG, liver enzymes, lipid levels, and HS rates. CONCLUSION: The frequency of PS was found 68.9% in Turkey. Its relationship was determined with age, BMI, HS, MS (and its components), pancreatic stiffness, and fecal elastase level.
Subject(s)
Elasticity Imaging Techniques , Fatty Liver , Metabolic Syndrome , Pancreatic Diseases , Humans , Turkey/epidemiology , Female , Middle Aged , Male , Prevalence , Adult , Risk Factors , Metabolic Syndrome/epidemiology , Pancreatic Diseases/epidemiology , Fatty Liver/epidemiology , Body Mass Index , Aged , Pancreas/diagnostic imaging , Pancreatic Elastase/analysis , Waist Circumference , Insulin Resistance , Blood Glucose/analysis , Blood Glucose/metabolismABSTRACT
BACKGROUND: Hepatitis B Virus (HBV) screening rates before starting immunosuppressive treatments are suboptimal. The aim of the study was to evaluate the efficacy of a new electronic alert system in increasing HBV screening rates. METHODS: The electronic alert system, HBVision2, identifies patients at risk of HBV reactivation when a pre-determined International Classification of Diseases (ICD)-10 code is entered into the hospital's database or immunosuppressive treatment is prescribed. The system evaluates the prior Hepatitis B Surfage Antigen (HBsAg) and anti-Hepatitis B Core Immunglobulin G (HBc IgG) results and sends an alert code to the clinician for screening if serology is not completely available or consult a specialist in case of positive serology. The HBV screening and consultation rates of patients before (control group) and after HBVision2 were retrospectively compared. The clinical course of unscreened and/or unconsulted patients was determined, and the clinical efficacy of HBVision2 in preventing HBVr was predicted. RESULTS: Control group included 815 patients (52.6% male, mean age: 60 ± 12, 82.5% with oncologic malignancy) and study group included 504 patients (56% male, mean age: 60 ± 13, 91.4% with oncologic malignancy). Groups were similar with respect to gender, mean age, and HBVr risk profile of the immunosuppressive treatment protocols. Overall, both HBsAg (from 55.1% to 93.1%) and anti- HBc IgG screening rates significantly increased (from 4.3% to 79.4%) after the electronic alert system (P < .001, for both). Consultation rates of anti-HBc IgG-positive patients significantly increased from 40% to 72.7% (P = .012). HBVr developed in 2 patients (2.6%) who were not screened and/or consulted after the alert system. Alert program prevented the development of HBVr in 10 patients (1.9%) of the study group and decreased the development of HBVr by 80%. CONCLUSION: Electronic alert system significantly improved HBsAg and anti-HBc IgG screening rates before starting immunosuppressive treatment and prevented the development of HBVr to a great extent. However, screening rates are still below optimal and need to be improved.
Subject(s)
Hepatitis B virus , Neoplasms , Humans , Male , Female , Hepatitis B virus/physiology , Hepatitis B Surface Antigens , Retrospective Studies , Immunosuppressive Agents/therapeutic use , Neoplasms/chemically induced , Neoplasms/drug therapy , Hepatitis B Antibodies , Electronics , Immunoglobulin GABSTRACT
BACKGROUND: Although current guidelines recommend cholecystectomy during the same admission in patients with mild acute biliary pancreatitis (ABP), it involves a waiting list most of the time. We aimed to assess the risk of complications and determine predictors during the waiting period for cholecystectomy after the first episode of ABP. METHODS: A prospective observational study was conducted in patients with mild ABP. Follow-ups were done by phone calls or using electronic health records for a maximum of 6 months after discharge or until cholecystectomy. RESULTS: A total of 194 patients were included in the study. Although all patients were referred to surgeons, only 81 (41.8%) underwent cholecystectomy within 6 months after discharge. During the observation period, gallstone-related biliary events (GRBEs) developed in 68 (35.1%) patients, which included biliary colic, recurrent ABP, acute cholecystitis, choledocholithiasis, gallbladder perforation, cholangitis, and liver abscess. The overall readmission rate was 25.2%, with 44.8% occurred within 4 weeks after discharge. The odds ratio of any complication was 1.58 (95% CI, 1.42 to 1.76, P =0.028) and 1.59 (95% CI, 1.42 to 1.78, P =0.009) in the patients who did not have surgery within 2 to 7 days and 8 to 15 days, respectively. A 4-fold increased risk of readmission was detected (95% CI, 1.16 to 13.70, P =0.019) if cholecystectomy was not performed within 31 to 90 days. The patients who developed complications had significantly higher C-reactive protein at admission, longer waiting time, and had 3 or more gallstones on imaging. CONCLUSIONS: Interval cholecystectomy was associated with a high risk of complications during the waiting period in patients with mild ABP.
Subject(s)
Cholecystitis, Acute , Gallstones , Pancreatitis , Humans , Time Factors , Cholecystectomy/adverse effects , Gallstones/complications , Gallstones/surgery , Cholecystitis, Acute/surgery , Pancreatitis/complications , Pancreatitis/surgeryABSTRACT
Graft Versus Host Disease (GVHD) is a severe immunological-clinicopathological condition mediated by healthy T-lymphocytes in donor tissue against the immunosuppressed host tissue and rarely seen after solid organ transplantation (SOT). A 72-year old male patient underwent cadaveric liver transplantation. On day 34 of the postoperative follow-up, the patient developed fever, generalized skin rash and hemorrhagic lesions in the oropharynx. Skin biopsy was consistent with GVHD. Despite high-dose corticosteroid treatment, he died on postoperative day 51. Although it is seen rarely after liver transplantation, GVHD is an important clinical entity for which early diagnosis is critical due to its high rates of mortality.
ABSTRACT
Hepatic myelopathy (HMy) is a rare neurological complication of liver cirrhosis that involves spastic paraplegia caused by lateral cord demyelination especially due to the accumulation of some metabolites such as ammonia and manganese. We report a young adult woman presenting with spasticity and paraparesis in extremities after intrahepatic portosystemic shunting (TIPS) application and underwent deceased liver transplantation (LT). A 39-year-old woman underwent deceased LT because of cryptogenic liver cirrhosis. She underwent a TIPS procedure 5 years ago. After that, hepatic encephalopathy and spasticity appeared. She was on the waiting list for 3 years. Neurological findings after LT significantly decreased, but did not return to normal. After the emergence of neurological findings, the earlier LT can provide improvement in neurological findings.
ABSTRACT
Background: This study aims to investigate the association between right atrial pressure and the Model for End-Stage Liver Disease score and to evaluate the ability of this scoring system to accurately predict the value of right atrial pressure. Methods: Between April 2016 and November 2018, a total of 137 patients (118 males, 19 females; median age: 49 years; range, 40 to 54 years) with advanced heart failure who were candidates for left ventricular assist device implantation or heart transplantation were retrospectively analyzed. We developed a formula calculated by using the biochemical and cardiac catheterization parameters of the patients. Results: There was a strong correlation between the right atrial pressure and the scores (r=0.510, p<0.001). The estimated right atrial pressure was calculated as "2 + (0.92 x Model for End-Stage Liver Disease Score)" (unstandardized coefficient 0.920, t value 7.674, p<0.001). The Model for End-Stage Liver Disease score was found to be an independent predictor of high right atrial pressure (odds ratio=1.491, 95% confidence interval: 1.244-1.786, p<0.001). The calculated area under the curve was 0.789 (95% confidence interval: 0.710-0.867, p<0.001) and the cut-off value of the Model for End-Stage Liver Disease score in the prediction of high right atrial pressure was 10.5 with 75% sensitivity and 73% specificity. Conclusion: We define a method to calculate right atrial pressure obtained by using the Model for End-Stage Liver Disease score without the need for cardiac catheterization during the hospitalization and follow-up period of patients with advanced heart failure.
ABSTRACT
INTRODUCTION: The aim of this study was to explore the relationship between the tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure (TAPSE/PASP) ratio and model for end-stage liver disease (MELD) score in patients with advanced heart failure. METHODS: A total of 103 patients with advanced heart failure evaluated for candidacy for heart transplantation were included in this study. TAPSE was measured by Mmode echocardiography and cardiac catheterization was performed. TAPSE/ PASP ratio and MELD score were calculated. RESULTS: The median age of patients was 49 (40.5-54) years and the majority were male (92%). The percentage of patients with ischemic cardiomyopathy was 40%. The mean value of the group's MELD score was 10⯱ 3.3 and the median value of TAPSE/PASP 0.24 (0.18-0.34). There was a moderate negative correlation between TAPSE/PASP and MELD score (r: -0.38, pâ¯< 0.001). Right atrial pressure (RAP) and left ventricular end-diastolic pressure (LVEDP) were also negatively correlated with TAPSE/PASP (correlation coefficients were r: -0.562 and r: -0.575, respectively). In patients with a lower TAPSE/PASP ratio, MELD score, LVEDP and RAP were higher and tricuspid regurgitation was more severe, but there were no significant differences between cardiac output (CO) and mean aortic pressure (mean BP). The presence of ischemia was found to be an independent predictor for lower values of TAPSE/PASP. CONCLUSION: The lower TAPSE/PASP obtained on echocardiography may be a sign of the multi-organ failure defined as a high MELD score in patients with advanced heart failure.
Subject(s)
End Stage Liver Disease , Heart Failure , Humans , Male , Middle Aged , Echocardiography, Doppler , End Stage Liver Disease/diagnosis , Heart Failure/diagnostic imaging , Pulmonary Artery/diagnostic imaging , Severity of Illness Index , Stroke Volume , Ventricular Function, RightABSTRACT
BACKGROUND/AIMS: An increased post-operative mortality risk has been reported among patients who undergo living donor liver transplantation (LDLT) with higher model for end-stage liver disease (MELD) scores. In this study, we investigated the effect of MELD score reduction on post-operative outcomes in patients with a high MELD (≥20) score by pre-transplant management. MATERIALS AND METHODS: We retrospectively analyzed 386 LDLT cases, and patients were divided into low-MELD (<20, n=293) vs. high-MELD (≥20, n=93) groups according to their MELD score at the time of index hospitalization. Patients in the high-MELD group were managed specifically according to a treatment algorithm in an effort to decrease the MELD score. Patients in the high-MELD group were further divided into 2 subgroups: (1) responders (n=34) to pre-transplant treatment with subsequent reduction of the MELD score by a minimum of 1 point vs. (2) non-responders (n=59), whose MELD score remained unchanged or further increased on the day of LDLT. Responders vs. non-responders were compared according to etiology, demographics, and survival.
Subject(s)
End Stage Liver Disease/surgery , Liver Transplantation/mortality , Living Donors , Preoperative Care/statistics & numerical data , Severity of Illness Index , End Stage Liver Disease/mortality , End Stage Liver Disease/pathology , Female , Humans , Liver Transplantation/methods , Male , Middle Aged , Predictive Value of Tests , Preoperative Care/methods , Preoperative Period , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND/AIMS: Sleep disorders (SDs) are frequently seen in patients with liver cirrhosis. Polysomnography (PSG), actigraphy, and electroencephalogram (EEG) are the common objective methods to diagnose SDs. The most commonly used subjective methods are the Pittsburgh sleep quality index (PSQI) and Epworth sleepiness scale (ESS). We aimed to evaluate the effect of liver transplantation (LTx) on SDs using a combination of objective (PSG and EEG) and subjective (PSQI and ESS) methods. MATERIALS AND METHODS: A total of 18 patients with cirrhosis on an LTx waiting list were included in this study. Patient clinical status and biochemical parameters were evaluated. All patients completed the validated Turkish forms of the PSQI and ESS before and 9 months after LTx. All patients underwent EEG and PSG before and 9 months after LTx. RESULTS: In total, 18 patients with liver cirrhosis (men: 12; 66.7%, mean age: 53.22±10.43 years) were included in this study. Pretransplant mean PSQI and ESS scores were 8.4±3.11 and 7.28±3.89, respectively; 9-month posttransplant mean PSQI and ESS scores were 4.5±2.8 and 4.72±2.91 (p<0.01), respectively. Before transplantation, metabolic encephalopathy was detected in 6 patients by EEG, whereas metabolic encephalopathy was detected in only 1 patient posttransplant. Posttransplantation PSG sleep duration (all stages) increased relative to pretransplant PSG values. Sleep latency and rapid eye movement latency were found to be reduced compared to the pretransplant values. CONCLUSION: This pilot study compared SDs in patients with pre- and post-LTx by combining the subjective and objective methods. Significant SD improvements were found at the 9th month.
Subject(s)
Electroencephalography/methods , Liver Cirrhosis/surgery , Liver Transplantation , Polysomnography/methods , Sleep Wake Disorders/diagnosis , Adult , Female , Humans , Liver Cirrhosis/complications , Liver Cirrhosis/physiopathology , Male , Middle Aged , Pilot Projects , Postoperative Period , Preoperative Period , Sleep , Sleep Wake Disorders/etiology , Treatment OutcomeABSTRACT
BACKGROUNDS: We evaluate whether it is safe to accept donors with Gilbert's syndrome (GS) for a living donor liver transplantation (LDLT) or not. This study is the first controlled study to be conducted. METHODS: Between January 2004 and May 2014, 600 LDLTs which used right lobe liver grafts were performed in our center. Forty-five of the 600 donors had a GS diagnosis. For a control group, 99 donors without GS who had completed 1 year or more of follow-up were selected retrospectively and consecutively. The clinical results of the donors and recipients were then analyzed. RESULTS: A total of 45 donors with GS and 99 donors without GS were included. There were no significant differences in patient demographics, actual graft weight, remnant ratio, portal and ductal variations, pre-peri-post-operative liver enzymes. The donors with GS had significantly higher bilirubin levels compared with the control group at first reading, at maximal peak, and post-operative 1-7 days, 1st and 6th months (P < .001 for all readings). Post-operative complication ratio was 40% in GS, 34.3% in non-GS group. In GS and non-GS group, hospitalization period was 10.2 and 9.2 days, respectively. The 1-year donor survival rate was 100% for both groups and 1-year recipient survival was similar who have donors with GS and non-GS (93.3%; 92.9%, P = .93). CONCLUSIONS: The use of right lobe grafts from donors with GS appears to be safe for donor health.
Subject(s)
Gilbert Disease , Liver Transplantation , Adult , Hepatectomy , Humans , Liver , Living Donors , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: There are limited data about the mortality and morbidity of patients with HBV flare related to immunosuppressive treatments (IST) in the third-generation antivirals era. Herein, we performed a multi-centric study in patients treated with entecavir (ETV) or tenofovir disoproxil fumarate (TDF) and evaluated their clinical course. METHODS: The study group included patients who were referred to gastroenterology or infectious disease specialists at eight different hospitals in Turkey. HBV flare was defined as at least a threefold elevation in alanine aminotransferase (ALT) levels above the upper limit of normal range. The demographic data, IST protocol, virological markers, liver tests, international normalized ratio (INR), HBV DNA, reactivation risk profile according to AGA guideline, MELD and MELD-Na scores were retrospectively evaluated. The primary aim of the study was to determine the liver-related mortality, including transplantation, at 12 weeks and factors predicting it. Secondary aims were to compare ETV and TDF with respect to mortality and time to ALT, bilirubin normalization and HBV DNA undetectability. RESULTS: The study group included 40 patients (29 males, mean age: 57 ±12 years). Twenty-five patients (62.5%) had a high risk of reactivation. Twenty-six patients received TDF and 14 patients received ETV treatment. Eight (20%) patients developed acute liver failure and one patient (2.5%) underwent living donor liver transplantation. Seven patients died due to liver-related complications, revealing a mortality rate of 17.5%. In multivariate analysis, total bilirubin levels at the onset, ALT levels and delta-MELD score at the first week were the independent risk factors for liver related mortality (HR: 1.222, 1.003, 1.253 and 95% CI: 1.096, 1.362; 1.001, 1.004 and 1.065, 1.470, respectively). There was no significant difference between the TDF and ETV groups with respect to time to normalize ALT and bilirubin levels, HBV DNA undetectability and mortality rates (16% and 21.4%, respectively). CONCLUSIONS: HBV flare associated with IST has a high mortality in the third-generation antivirals era. High total bilirubin at the onset and high ALT and delta-MELD score at the first week predict poor prognosis.
Subject(s)
Hepatitis B/etiology , Immunosuppressive Agents/adverse effects , Alanine Transaminase/blood , Antiviral Agents/therapeutic use , Female , Guanine/analogs & derivatives , Guanine/therapeutic use , Hepatitis B/blood , Hepatitis B/drug therapy , Hepatitis B/mortality , Humans , Liver Transplantation , Male , Middle Aged , Retrospective Studies , Symptom Flare Up , Tenofovir/therapeutic useABSTRACT
BACKGROUND: Liver transplantation (LT) is the best treatment in selected patients with hepatocellular carcinoma (HCC). Morphologic criteria alone are not sufficient to predict survival. In this study, we investigated the clinical, biochemical, and pathologic factors affecting survival in patients who underwent LT due to HCC. METHODS: Between October 2011 and January 2018, 165 of 749 LT for HCC cases performed at the Memorial Atasehir Hospital were evaluated retrospectively. Survival, demographic characteristics and etiology, preoperative alpha-fetoprotein (AFP) level, Model for End-Stage Liver Disease (MELD) score, prognostic staging, and morphologic and histologic properties were evaluated. RESULTS: One hundred and thirty-nine cases of 165 were living donor liver transplantation (LDLT). The mean age was 57.7 ± 7.3 years, the mean follow-up period was 27.8 ± 20 months, and 41 patients (24%) died before follow-up. Recurrence of HCC was detected in 23 (14%) cases. Overall survival was 85%, 71%, and 64% for 1, 3, and 5 years, respectively. In terms of 1-, 3-, and 5-year survival within vs beyond Milan criteria was 90%, 80%, and 76% vs 75%, 66%, and 44%, respectively. In the University of California San Francisco criteria, it was 86%, 76%, and 70% vs 76%, 60%, and 30% compared with 1-, 3-, and 5-year survival. While histopathological poor differentiation and AFP elevation affected the course negatively. Good differentiation did not have a significant effect on survival. It was determined that poor differentiation, lymphovascular invasion, and an increased number of nodules significantly affected survival in both within and beyond cases. CONCLUSION: A transplant decision is controversial in patients with HCC with other than previously defined morphologic criteria. In these cases, AFP level and histologic differentiation determine survival. The results were not satisfactory in both high and/or poorly differentiated cases.
Subject(s)
Carcinoma, Hepatocellular/surgery , Liver Neoplasms/surgery , Liver Transplantation/mortality , Liver Transplantation/methods , Adult , Aged , Carcinoma, Hepatocellular/mortality , Female , Humans , Liver Neoplasms/mortality , Living Donors , Male , Middle Aged , Prognosis , Retrospective Studies , Risk Factors , San FranciscoABSTRACT
Posterior reversible encephalopathy syndrome (PRES) is a neuroradiologic syndrome. The etiology of PRES is still unclear. Some factors were described. We present a case of a pediatric patient with liver transplant who developed PRES following blood transfusion while receiving tacrolimus therapy. A 5½-year-old boy who underwent living donor liver transplantation, and PRES developed on the sixth day post transplant under tacrolimus treatment after 6 hours of red blood transfusion. PRES is a rare condition; it should be kept in mind about patients who have received organ transplants and develop sudden neurologic symptoms.
Subject(s)
Liver Transplantation/adverse effects , Posterior Leukoencephalopathy Syndrome/etiology , Blood Transfusion , Child, Preschool , Humans , Immunosuppressive Agents/therapeutic use , Living Donors , Male , Tacrolimus/therapeutic useABSTRACT
The last two decades have seen a paradigm shift in the selection of patients with hepatocellular carcinoma (HCC) for liver transplantation. Microvascular invasion and differentiation have been the most significant factors affecting post-transplant recurrence; however, because of inherent disadvantages of pre-transplant biopsy, histological criteria never gained popularity. Recently, the selection criteria evolved from morphological to biological criteria, such as biomarkers and response to loco-regional therapy. With the introduction of multimodality imaging, combination of computed tomography with nuclear medicine imaging, particularly, 18F-fluorodeoxyglucose positron emission tomography fulfilled an unmet need and rapidly became a critical component of HCC management. This review article will focus on the use of 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography in the pre-transplant evaluation of HCC patients with special discussion on its ability to predict HCC recurrence after liver transplantation.
ABSTRACT
OBJECTIVE: Myocardial involvement in systemic lupus erythematosus (SLE) has great importance. The aim of this study is to evaluate the rotation and twisting mechanics of the left ventricle (LV) in patients with SLE. METHODS: Forty-three patients fulfilled at least four of the American College of Rheumatology criteria for SLE and 30 individuals as controls were included in the study. SLE disease activity was assessed using the SELENA-SLEDAI score. Echocardiography was performed for all subjects. The patients fulfilled at least four of the American College of Rheumatology criteria for SLE were enrolled in the study. SLE disease activity was assessed using the SELENA-SLEDAI score. Echocardiography was performed for all individuals.Comparisons between groups were made using independent samples t-test with the standard statistical software (SPSS, version 15.0; SPSS Inc., Chicago, IL, USA). Each image was digitally stored for offline analysis. Measurement of global strain assessed by 17-segment model and rotational parameters were performed. LV ejection fraction was calculated by the biplane Simpson's method. Comparisons between groups were made using the independent samples t-test with the standard statistical software. A p value of 0.05 was considered statistically significant. RESULTS: The values of mean global longitudinal strain, basal global circumferential strain (GCS), mean basal radial strain, and apical GCS were significantly lower in SLE patients. The difference between basal rotation, apical rotation, twist of the LV, and torsion of the LV in the SLE patients and controls were not significant (8.8±5.5 vs. 10.6±5.8, p=0.183;-4.7±3.0 vs. -4.8±3.2, p=0.947; 11.7±6.4 vs. 13.2±6.4, p=0.366; and 1.8±0.8 vs. 1.9±2.3, p=0.725, respectively). Although there was not any significant relationship between SELENA-SLEDAI score and myocardial strain analyses of the LV, the basal rotation and the torsion of the LV were lower in patients with SLE having a SLEDAI score of ≥17 (p=0.024 for basal rotation and p=0.032 for torsion). CONCLUSION: The number of segmental and global strain analyses were decreased in SLE patients with globally normal LVEF. The twist and torsion mechanics of the LV were preserved according to the control group, and the left ventricular torsion and basal rotation were found to be significantly decreased in those with an activity score of ≥17.
Subject(s)
Heart Ventricles/diagnostic imaging , Lupus Erythematosus, Systemic/physiopathology , Ventricular Dysfunction, Left , Biomechanical Phenomena , Echocardiography , Female , Heart Ventricles/physiopathology , Humans , Male , Rotation , Ventricular Function, LeftABSTRACT
INTRODUCTION: P wave axis is one of the most practical clinical tool for evaluation of cardiovascular disease. The aim of our study was to evaluate the P wave axis in electrocardiogram (ECG), left atrial function and association between the disease activity score in patients with systemic lupus erythematosus (SLE). METHODS: Standard 12-lead surface ECGs were recorded by at a paper speed of 25 m/s and an amplifier gain of 10 mm/mV. The heart rate (HR), the duration of PR, QRS, QTd (dispersion), the axis of P wave were measured by ECG machine automatically. RESULTS: The P wave axis was significantly increased in patients with SLE (49 ± 20 vs. 40 ± 18, P = 0.037) and the disease activity score was found positively correlated with P wave axis (r: 0.382, P = 0.011). The LA volume and the peak systolic strain of the left atrium (LA) were statistically different between the groups (P = 0.024 and P = 0.000). The parameters of the diastolic function; E/A and E/e' were better in the control group than the patients with SLE (1.1 ± 0.3 vs. 1.3 ± 0.3, P = 0.041 and 6.6 ± 2.8 vs. 5.4 ± 1.4, P = 0.036, respectively). CONCLUSION: P wave axis was found significantly increased in patients with SLE and positively correlated with SELENA-SLEDAI score. As the risk score increases in patients with SLE, P wave axis changes which may predict the risk of all-cause and cardiovascular mortality.