Fragmented QRS complexes are a marker of myocardial fibrosis in hypertensive heart disease

Kilci, Hakan; ÇELİK, OĞUZHAN; Yetim, Mucahit; BEKAR, Lütfü; ÖNALAN, Orhan; Katar, Muzaffer

Fragmented QRS complexes are a marker of myocardial fibrosis in hypertensive heart disease

Lütfü BEKAR, (Hitit Üniversitesi, Çorum Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, Çorum, Türkiye)

Muzaffer KATAR, (Tokat Devlet Hastanesi, Tıbbi Biyokimya Anabilim Dalı, Tokat, Türkiye)

Mücahit YETİM, (Hitit Üniversitesi, Çorum Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, Çorum, Türkiye)

Oğuzhan ÇELİK, (Hitit Üniversitesi, Çorum Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, Çorum, Türkiye)

Hakan KİLCİ, (Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi, Kardiyoloji, Anabilim Dalı, İstanbul, Türkiye)

Orhan ÖNALAN (Karabük Üniversitesi, Tıp Fakültesi, Kardiyoloji Ana Bilim Dalı, Karabük, Türkiye)

Türk Kardiyoloji Derneği Arşivi

1 0

Yıl: 2016 Cilt: 44 Sayı: 7 Sayfa Aralığı: 554 - 560 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Fragmented QRS complexes are a marker of myocardial fibrosis in hypertensive heart disease

Öz:

Amaç: Karboksi terminal propeptid tip 1 prokollajen (PICP) hücre dışı kollajen sentezinin bir göstergesidir. On iki kanallı elektrokardiyografide (EKG) tespit edilen parçalı QRS'in (fQRS) miyokart fibrozunun bir belirteci olduğu gösterilmiştir. Bu çalışmada, hipertansiyonlu hastalarda serum PICP düzeyleri ile EKG'de saptanan fQRS arasındaki ilişkiyi araştırmayı amaçladık.Yöntemler: Yeni veya eski tanılı ardışık hipertansiyonlu hastalar dahil edildi. Parçalanmış QRS birbirini takip eden iki EKG derivasyonunda ilave R dalgası (R') veya R veya S dalgasında çentiklenme veya bölünme varlığı olarak alındı. Serum PICP düzeyleri ELISA yöntemiyle ölçüldü.Bulgular: Çalışmaya 90 hipertansiyonlu hasta alındı (%74 kadın, ortalama yaş 54.7±8.5 yıl). Bunlardan 47'sinde (%52.2) EKG'de fQRS saptandı. Yaş (p=0.121) ve cinsiyet dağılımı bakımından (p=0.625) fQRS'si olan ve olmayan gruplar birbirine benzerdi. Alıcı işlemci karakteristik eğrisi analizi ile PICP düzeylerinin fQRS varlığı için güçlü bir öngördürücü yeteneğe sahip olduğu görüldü (eğri altında kalan alan=0.850, %95 GA 0.772-0.929, p<0.0001). Çok değişkenli lojistik regresyon analizinde PICP düzeyleri fQRS için güçlü ve bağımsız bir öngördürücü idi (OO [odds oranı] 1.938, %95 GA 1.398-2.688).Sonuç: Serum PICP düzeyleri fQRS'nin güçlü ve bağımsız bir belirtecidir. PICP düzeylerinin fQRS için ayırt edici performansı yüksektir. Biz bu çalışmada fQRS'nin hipertansif hastalarda miyokart fibrozunu yansıtabileceğini gösteren ilk kanıtları sunduk.

Anahtar Kelime:

Konular: Kalp ve Kalp Damar Sistemi

Parçalı QRS kompleksleri hipertansif kalp hastalığında miyokart fibrozunun bir belirtecidir

Öz:

Objective: Carboxy-terminal propeptide of type 1 procollagen (PICP) is a marker of extracellular collagen synthesis. Fragmented QRS (fQRS) on a 12-lead electrocardiogram (ECG) has been demonstrated as a marker of myocardial fibrosis. The present objective was to investigate the association between serum PICP concentration and presence of fQRS on ECG in hypertensive patients.Methods: Consecutive patients with previously or newly diagnosed hypertension were included. fQRS was defined as the presence of additional R-wave (R'), or notching of R- or Swaves, or the presence of fragmentation in 2 contiguous ECG leads. Serum PICP levels were measured by ELISA method.Results: The study group consisted of 90 hypertensive patients (74% females, with a mean age of 54.7±8.5 years). Of these patients, 47 (52.2%) had fQRS on ECG. Age (p=0.121) and gender distribution (p=0.625) were similar in patients with or without fQRS. Receiver operating characteristic curve analysis yielded a strong predictive ability of PICP levels for the presence of fQRS (area under the curve: 0.850; 95% CI: 0.772-0.929; p<0.0001). In multivariate logistic regression analysis, PICP levels were strongly and independently associated with the presence of fQRS (OR: 1.938; 95% CI: 1.398-2.688).Conclusion: Serum PICP level is a strong and independent predictor of fQRS. Discriminative performance of serum PICP levels for the presence of fQRS is high. The present results are the first to demonstrate that fQRS may indicate myocardial fibrosis in patients with hypertension.

Anahtar Kelime:

Konular: Kalp ve Kalp Damar Sistemi

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

Rossi MA. Pathologic fibrosis and connective tissue matrix in left ventricular hypertrophy due to chronic arterial hyperten- sion in humans. J Hypertens 1998;16:1031-41.
Querejeta R, Varo N, Lopez B, Larman M, Artinano E, Etayo JC, et al. Serum carboxy-terminal propeptide of procollagen type I is a marker of myocardial fibrosis in hypertensive heart disease. Circulation 2000;101:1729-35.
Cuspidi C, Ciulla M, Zanchetti A. Hypertensive myocardial fibrosis. Nephrol Dial Transplant 2006;21:20-3.
Take Y, Morita H. Fragmented QRS: What Is The Meaning? Indian Pacing Electrophysiol J 2012;12:213-25.
Basaran Y, Tigen K, Karaahmet T, Isiklar I, Cevik C, Gurel E, et al. Fragmented QRS complexes are associated with cardiac fibrosis and significant intraventricular systolic dyssynchrony in nonischemic dilated cardiomyopathy patients with a nar- row QRS interval. Echocardiography 2011;28:62-8.
Das MK, Suradi H, Maskoun W, Michael MA, Shen C, Peng J, et al. Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis. Circ Arrhythm Electro- physiol 2008;1:258-68.
Park SJ, On YK, Kim JS, Park SW, Yang JH, Jun TG, et al. Relation of fragmented QRS complex to right ventricular fi- brosis detected by late gadolinium enhancement cardiac mag- netic resonance in adults with repaired tetralogy of fallot. Am J Cardiol 2012;109:110-5.
Homsi M, Alsayed L, Safadi B, Mahenthiran J, Das MK. Fragmented QRS complexes on 12-lead ECG: a marker of cardiac sarcoidosis as detected by gadolinium cardiac mag- netic resonance imaging. Ann Noninvasive Electrocardiol 2009;14:319-26.
Terho HK, Tikkanen JT, Junttila JM, Anttonen O, Kenttä TV, Aro AL, et al. Prevalence and prognostic significance of fragmented QRS complex in middle-aged subjects with and without clinical or electrocardiographic evidence of cardiac disease. Am J Cardiol 2014;114:141-7.
Fares H, Heist K, Lavie CJ, Kumbala D, Ventura H, Meadows R, et al. Fragmented QRS complexes-a novel but underuti- lized electrocardiograhic marker of heart disease. Crit Pathw Cardiol 2013;12:181-3.
Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantifi- cation: a report from the American Society of Echocardiogra- phy's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005;18:1440-63.
Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, et al. Echocardiographic assessment of left ven- tricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986;57:450-8.
Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013;31:1281-357.
Das MK, Zipes DP. Fragmented QRS: a predictor of mortality and sudden cardiac death. Heart Rhythm 2009;6(3 Suppl):8-14.
Kannel WB. Prevalence and natural history of electrocardiographic left ventricular hypertrophy. Am J Med 1983;75(3A):4-11.
Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK. The progression from hypertension to congestive heart failure. JAMA 1996;275:1557-62.
Gonzalez A, Lopez B, Diez J. Myocardial fibrosis in arterial hypertension. European Heart J Supplements 2002;4(Suppl D):18-22.
Jellis C, Martin J, Narula J, Marwick TH. Assessment of nonischemic myocardial fibrosis. J Am Coll Cardiol 2010;56:89- 97.
Díez J, Panizo A, Gil MJ, Monreal I, Hernández M, Pardo Mindán J. Serum markers of collagen type I metabolism in spontaneously hypertensive rats: relation to myocardial fibrosis. Circulation 1996;93:1026-32.
Morita H, Kusano KF, Miura D, Nagase S, Nakamura K, Morita ST, et al. Fragmented QRS as a marker of conduction abnormality and a predictor of prognosis of Brugada syndrome. Circulation 2008;118:1697-704.
Zhang B, Zhen Y, Shen D, Zhang G. Significance of fragmented QRS complexes for identifying left ventricular hypertrophy in patients with hypertension. Ann Noninvasive Electrocardiol 2015;20:175-80.
Bekar L, Celebi S. Fragmented QRS and Left Ventricular Geometry in Hypertensive Patients. Kosuyolu Kalp Derg 2013;16:93-8.
Temiz A, Gazi E, Güngör O, Altun B, Barutcu A, Bekler A, et al. Fragmented QRS and prediction of paroxysmal atrial fibrillation episodes. Pak J Med Sci 2014;30:862-7.
Bekar L. Fragmented QRS and atrial arrhythmias in hypertensive patients. 10th Mediterranean Meeting on Hypertension and Atherosclerosis, 2013. p. 6.
Kannel WB. Left ventricular hypertrophy as a risk factor in arterial hypertension. Eur Heart J 1992;13 Suppl D:82-8.
Messerli FH, Soria F. Hypertension, left ventricular hypertrophy, ventricular ectopy, and sudden death. Am J Med 1992;93:21-6.

APA	BEKAR L, Katar M, Yetim M, ÇELİK O, Kilci H, ÖNALAN O (2016). Fragmented QRS complexes are a marker of myocardial fibrosis in hypertensive heart disease. , 554 - 560.
Chicago	BEKAR Lütfü,Katar Muzaffer,Yetim Mucahit,ÇELİK OĞUZHAN,Kilci Hakan,ÖNALAN Orhan Fragmented QRS complexes are a marker of myocardial fibrosis in hypertensive heart disease. (2016): 554 - 560.
MLA	BEKAR Lütfü,Katar Muzaffer,Yetim Mucahit,ÇELİK OĞUZHAN,Kilci Hakan,ÖNALAN Orhan Fragmented QRS complexes are a marker of myocardial fibrosis in hypertensive heart disease. , 2016, ss.554 - 560.
AMA	BEKAR L,Katar M,Yetim M,ÇELİK O,Kilci H,ÖNALAN O Fragmented QRS complexes are a marker of myocardial fibrosis in hypertensive heart disease. . 2016; 554 - 560.
Vancouver	BEKAR L,Katar M,Yetim M,ÇELİK O,Kilci H,ÖNALAN O Fragmented QRS complexes are a marker of myocardial fibrosis in hypertensive heart disease. . 2016; 554 - 560.
IEEE	BEKAR L,Katar M,Yetim M,ÇELİK O,Kilci H,ÖNALAN O "Fragmented QRS complexes are a marker of myocardial fibrosis in hypertensive heart disease." , ss.554 - 560, 2016.
ISNAD	BEKAR, Lütfü vd. "Fragmented QRS complexes are a marker of myocardial fibrosis in hypertensive heart disease". (2016), 554-560.

APA	BEKAR L, Katar M, Yetim M, ÇELİK O, Kilci H, ÖNALAN O (2016). Fragmented QRS complexes are a marker of myocardial fibrosis in hypertensive heart disease. Türk Kardiyoloji Derneği Arşivi, 44(7), 554 - 560.
Chicago	BEKAR Lütfü,Katar Muzaffer,Yetim Mucahit,ÇELİK OĞUZHAN,Kilci Hakan,ÖNALAN Orhan Fragmented QRS complexes are a marker of myocardial fibrosis in hypertensive heart disease. Türk Kardiyoloji Derneği Arşivi 44, no.7 (2016): 554 - 560.
MLA	BEKAR Lütfü,Katar Muzaffer,Yetim Mucahit,ÇELİK OĞUZHAN,Kilci Hakan,ÖNALAN Orhan Fragmented QRS complexes are a marker of myocardial fibrosis in hypertensive heart disease. Türk Kardiyoloji Derneği Arşivi, vol.44, no.7, 2016, ss.554 - 560.
AMA	BEKAR L,Katar M,Yetim M,ÇELİK O,Kilci H,ÖNALAN O Fragmented QRS complexes are a marker of myocardial fibrosis in hypertensive heart disease. Türk Kardiyoloji Derneği Arşivi. 2016; 44(7): 554 - 560.
Vancouver	BEKAR L,Katar M,Yetim M,ÇELİK O,Kilci H,ÖNALAN O Fragmented QRS complexes are a marker of myocardial fibrosis in hypertensive heart disease. Türk Kardiyoloji Derneği Arşivi. 2016; 44(7): 554 - 560.
IEEE	BEKAR L,Katar M,Yetim M,ÇELİK O,Kilci H,ÖNALAN O "Fragmented QRS complexes are a marker of myocardial fibrosis in hypertensive heart disease." Türk Kardiyoloji Derneği Arşivi, 44, ss.554 - 560, 2016.
ISNAD	BEKAR, Lütfü vd. "Fragmented QRS complexes are a marker of myocardial fibrosis in hypertensive heart disease". Türk Kardiyoloji Derneği Arşivi 44/7 (2016), 554-560.