Turkiye Klinikleri Cardiovascular Sciences

.: REVIEW
Tpeak-Tend Interval and its Derivatives as Indices of Repolarization Dispersion and Arrhythmic Risk: Traditional Review
Repolarizasyon Dağılımı ve Aritmik Risk Göstergeleri Olarak Tpeak-Tend Aralığı ve Türevleri: Geleneksel Derleme
Natalia ARTEYEVAa
aDepartment of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, Syktyvkar, Russia
Turkiye Klinikleri J Cardiovasc Sci. 2024;36(1):27-34
doi: 10.5336/cardiosci.2023-100358
Article Language: EN
Full Text
ABSTRACT
 Development of life-threatening ventricular arrhythmias is often associated with an increase in the dispersion of ventricular repolarization (DOR), which can be detected by electrocardiographic (ECG) methods. For several decades, there was an active search for ECG markers reflecting the magnitude of DOR and the associated arrhythmic risk. The interval from the peak to the end of the T-wave (Tpe) was found to be the most accurate measure of DOR and a reliable marker of arrhythmic risk in various cardiac disorders. In addition to Tpe interval itself, its derivatives-Tpe dispersion and Tpe/QT ratiowere proposed as arrhythmic risk markers. In this review, several aspects regarding Tpe and its derivatives are discussed: (1) physiological rationale for relationship to DOR and arrhythmic risk, (2) clinical significance for predicting ventricular arrhythmias, and (3) clinical limitations. Based on the experimental, clinical and simulation studies, the review demonstrates that Tpe, dTpe and Tpe/QT ratio are informative concerning both the global and the local DOR. They are significant predictors of arrhythmias associated with increased DOR, and the overall mortality. Besides, Tpe magnitude showed itself as a simple, non-invasive, inexpensive and quick indirect assessment of hemodynamic and volumetric ventricular parameters, the extent and severity of coronary artery stenosis, therapy response and the expected hospital stay. However, the lack of consensus in measurements led to large variations of cut-off values reported by different researchers. The inclusion of Tpe in routine ECG analysis requires further research based on the more unified measurements, including machine learning and artificial intelligence tools.

Keywords: Repolarization dispersion; arrhythmic risk; Tpeak-Tend interval; Tpeak-Tend dispersion; Tpeak-Tend/QT ratio
ÖZET
 Hayatı tehdit eden ventriküler aritmilerin gelişimi, genellikle elektrokardiyografik (EKG) yöntemlerle tespit edilebilen ventriküler repolarizasyon dispersiyonundaki [dispersion of ventricular repolarization (DOR)] bir artışla ilişkilidir. Onlarca yıl boyunca, DOR'un büyüklüğünü ve ilgili aritmik riski yansıtan EKG belirteçleri için aktif bir araştırma yapılmıştır. T-dalga zirvesinden sonuna kadar olan aralık (Tpe), DOR'un en doğru ölçüsü ve çeşitli kardiyak bozukluklarda güvenilir bir aritmik risk belirteci olarak bulunmuştur. Tpe aralığının kendisine ek olarak, türevleri - Tpe dispersiyonu ve Tpe/QT oranıaritmik risk belirteçleri olarak önerilmiştir. Bu derlemede, Tpe ve türevlerine ilişkin çeşitli yönler tartışılmaktadır: (1) DOR ve aritmik risk ile ilişki için fizyolojik gerekçe, (2) ventriküler aritmilerin öngörülmesinde klinik önem ve (3) klinik kısıtlamalar. Deneysel, klinik ve simülasyon çalışmalarına dayanarak, bu derleme, Tpe, dTpe ve Tpe/QT oranının hem küresel hem de lokal DOR hakkında bilgilendirici olduğunu göstermektedir. Bunlar, artmış DOR ile ilişkili aritmilerin ve genel mortalitenin önemli öngörücüleridir. Ayrıca Tpe büyüklüğü hemodinamik ve volümetrik ventriküler parametrelerin, koroner arter stenozunun kapsamı ve şiddeti, tedaviye yanıtın ve beklenen hastanede kalış süresinin basit, invaziv olmayan, ucuz ve hızlı bir dolaylı değerlendirmesi olarak kendini göstermiştir. Ancak ölçümlerde fikir birliği olmaması, farklı araştırmacılar tarafından bildirilen eşik değerlerinde büyük farklılıklara yol açmıştır. Tpe'nin rutin EKG analizine dâhil edilmesi, daha birleşik ölçümlere dayanan, makine öğrenimi ve yapay zekâ araçlarını içeren daha fazla araştırma gerektirmektedir.

Anahtar Kelimeler: Repolarizasyon dispersiyonu; aritmik risk; Tpeak-Tend aralığı; Tpeak-Tend dispersiyonu; Tpeak-Tend/QT oranı
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4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com