Hipertansif Hastalarda Fragmente QRS ve Sol Ventrikül Geometrisi

BEKAR, Lütfü; ÇELEBİ, Savaş A

Hipertansif Hastalarda Fragmente QRS ve Sol Ventrikül Geometrisi

Lütfü BEKAR, (Tokat Devlet Hastanesi, Kardiyoloji Kliniği, Tokat, Türkiye)

Savaş A ÇELEBİ (Tokat Devlet Hastanesi, Kardiyoloji Kliniği, Tokat, Türkiye)

Koşuyolu Heart Journal

17 1

Yıl: 2013 Cilt: 16 Sayı: 2 Sayfa Aralığı: 93 - 98 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Hipertansif Hastalarda Fragmente QRS ve Sol Ventrikül Geometrisi

Öz:

Giriş: Fragmente QRS rutin EKG kayıtlarında saptanan bir depolarizasyon bozukluğudur. Miyokart fi brozisi sonrası gelişen ileti kusuruna bağlı geliştiği bilinmektedir. Sol ventrikül hipertrofi sinde miyositler hipertrofi olurken interstisyumda abartılı bir kollajen birikimi olur, bu da miyokardiyal fi brozise neden olur. Bu çalışmada hipertansif hastaların rutin EKG kayıtlarında saptanan fragmente QRS'nin sol ventrikül geometrisi ile olan ilişkisini araştırmayı planladık.Hastalar ve Yöntem: Çalışmamıza hastanemize ayaktan başvuran esansiyel hipertansiyon hastaları dahil edildi. Çalışmaya dahil edilen tüm hastalardan 12 derivasyonlu istirahat EKG'si çekildi. Transtorasik ekokardiyografi yle sol ventrikül kitle indeksi ve göreceli duvar kalınlığı kullanılarak sol ventrikül geometrisi belirlendi.Bulgular: Çalışmamıza EKG kaydında fragmente QRS saptanan 67 hasta ile fragmente QRS saptanmayan 63 hasta alındı. Fragmente QRS saptanan grup olmayanla kıyaslandığında sol atriyum çapının daha geniş olduğu, sol ventrikül kitlesi ve sol ventrikül kitle indeksinin daha fazla olduğu saptandı. Fragmente QRS saptanan grupta konsantrik ve eksantrik hipertrofi daha fazla görülürken, saptanmayan grupta normal geometri ve konsantrik remodelling daha fazla idi.Sonuç: Fragmente QRS'ye sahip hipertansif hastalarda sol ventrikül hipertrofi si olmayanlara göre daha sık izlenir. Bu durum sol ventrikül hipertrofi sindeki artmış miyokardiyal fi brozis ile ilişkili olabilir. Fragmente QRS varlığı hipertansif hastalarda risk sınıfl amasında kullanılabilir

Anahtar Kelime:

Konular: Kalp ve Kalp Damar Sistemi

Fragmented QRS and Left Ventricular Geometry in Hypertensive Patients

Öz:

Introduction: Fragmented QRS is a depolarization abnormality detected with routin ECG recording. It is related with conduction defect which occurs after myocardial fi brosis. In the left ventricular hypertrophy, an excessive amount of collagen accumulates in the interstitium when the myocytes became hypertrophied, resulting in myocardial fi brosis. In this study, we aimed to investigate the relationship of fragmented QRS which was detected on ECG recordings of the hypertensive patients with the left ventricular geometry.Patients and Methods: Essential hypertension patients referred to our hospital on outpatient bases were included in the study. 12-lead resting ECG was taken in all the patients. Left ventricular geometry defi ned using left ventricular mass index and relative wall thickness with transthorasic echocardiography.Results: Sixy seven patients with fragmented QRS and 63 patients without fragmented QRS included the study. We found that patients in the group with fragmented QRS detected have a wider mean left atrium diameter, greater left ventricular mass and left ventricular mass index compared with the group without fragmented QRS. Concentric and eccentric hypertrophy were more common in fragmented QRS group, while normal geometry and concentric remodelling have greater rates in the normal group.Conclusion: Left ventricular hypertrophy is observed more frequently in the patients with fragmented QRS than without fragmented QRS. This may be associated with the increased myocardial fi brosis in the left ventricular hypertrophy. Existence of fragmented QRS can be used for risk stratifi cation in the hypertensive patients

Anahtar Kelime:

Konular: Kalp ve Kalp Damar Sistemi

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

1. Le Heuzey JY, Guize L. Cardiac prognosis in hypertensive patients. Incidence of sudden death and ventricular arrhythmias. Am J Med 1988;84(1B):65-8.
2. New approaches to antiarrhythmic therapy, Part I: emerging therapeutic applications of the cell biology of cardiac arrhythmias. Circulation 2001;104:2865-73.
3. Kahan T, Bergfeldt L. Left ventricular hypertrophy in hypertension: its arrhythmogenic potential. Heart 2005;91:250-6. PubMed PMID: 15657259.
4. Verdecchia P, Angeli F, Borgioni C, Gattobigio R, de Simone G, Devereux RB, et al. Changes in cardiovascular risk by reduction of left ventricular mass in hypertension: a meta-analysis. Am J Hypertens 2003;16(11 Pt 1):895-9.
5. Das MK, Zipes DP. Fragmented QRS: a predictor of mortality and sudden cardiac death. Heart Rhythm 2009;6(3 Suppl):S8-14.
6. 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.
7. Das MK, Saha C, El Masry H, Peng J, Dandamudi G, Mahenthiran J, et al. Fragmented QRS on a 12-lead ECG: a predictor of mortality and cardiac events in patients with coronary artery disease. Heart Rhythm 2007;4:1385-92.
8. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 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 2007;25:1105-87.
9. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 2003;42:1206-52.
10. Lip GY. Regression of left ventricular hypertrophy and improved prognosis: some hope now . . . or hype? Circulation 2001;104:1582-4.
11. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 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). Eur Heart J 2007;28:1462- 536.
12. Roman MJ, Pickering TG, Schwartz JE, Pini R, Devereux RB. Relation of arterial structure and function to left ventricular geometric patterns in hypertensive adults. J Am Coll Cardiol 1996;28:751-6.
13. Ganau A, Devereux RB, Roman MJ, de Simone G, Pickering TG, Saba PS, et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol 1992;19:1550-8.
14. Gardner PI, Ursell PC, Fenoglio JJ Jr, Wit AL. Electrophysiologic and anatomic basis for fractionated electrograms recorded from healed myocardial infarcts. Circulation 1985;72:596-611.
15. Das MK, Khan B, Jacob S, Kumar A, Mahenthiran J. Signifi cance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease. Circulation 2006;113:2495-501.
16. Onalan O, Bekar L, Ceyhan K. Prevalence and association of fragmented QRS in hypertensive patients. J Am Coll Cardiol 2011; 57:E 118.
17. Kannel WB. Prevalence and natural history of electrocardiographic left ventricular hypertrophy. Am J Med 1983;75(3A):4-11.
18. Casale PN, Devereux RB, Milner M, Zullo G, Harshfi eld GA, Pickering TG, et al. Value of echocardiographic measurement of left ventricular mass in predicting cardiovascular morbid events in hypertensive men. Ann Intern Med 1986;105:173-8.
19. Liao Y, Cooper RS, McGee DL, Mensah GA, Ghali JK. The relative effects of left ventricular hypertrophy, coronary artery disease, and ventricular dysfunction on survival among black adults. JAMA 1995;273:1592-7.
20. Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK. The progression from hypertension to congestive heart failure. JAMA 1996;275:1557-62.
21. Kannel WB. Left ventricular hypertrophy as a risk factor in arterial hypertension. Eur Heart J 1992;13(Suppl D):82-8.
22. Messerli FH, Grodzicki T. Hypertension, left ventricular hypertrophy, ventricular arrhythmias and sudden death. Eur Heart J 1992;13(Suppl D):66-9.
23. Matsuda M, Matsuda Y. Mechanism of left atrial enlargement related to ventricular diastolic impairment in hypertension. Clin Cardiol 1996;19:954-9.
24. Koren MJ, Devereux RB, Casale PN, Savage DD, Laragh JH. Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med 1991;114:345-52.
25. Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Gattobigio R, Zampi I, et al. Prognostic value of left ventricular mass and geometry in systemic hypertension with left ventricular hypertrophy. Am J Cardiol 1996;78:197-202.
26. Schwartzkopff B, Brehm M, Mundhenke M, Strauer BE. Repair of coronary arterioles after treatment with perindopril in hypertensive heart disease. Hypertension 2000;36:220-5.
27. Brilla CG, Funck RC, Rupp H. Lisinopril-mediated regression of myocardial fi brosis in patients with hypertensive heart disease. Circulation 2000;102:1388-93.
28. Lopez B, Querejeta R, Varo N, Gonzalez A, Larman M, Martinez Ubago JL, et al. Usefulness of serum carboxy-terminal propeptide of procollagen type I in assessment of the cardioreparative ability of anti-hypertensive treatment in hypertensive patients. Circulation 2001;104:286-91.
29. Jellis C, Martin J, Narula J, Marwick TH. Assessment of nonischemic myocardial fi brosis. J Am Coll Cardiol 56:89-97.

APA	BEKAR L, ÇELEBİ S (2013). Hipertansif Hastalarda Fragmente QRS ve Sol Ventrikül Geometrisi. , 93 - 98.
Chicago	BEKAR Lütfü,ÇELEBİ Savaş A Hipertansif Hastalarda Fragmente QRS ve Sol Ventrikül Geometrisi. (2013): 93 - 98.
MLA	BEKAR Lütfü,ÇELEBİ Savaş A Hipertansif Hastalarda Fragmente QRS ve Sol Ventrikül Geometrisi. , 2013, ss.93 - 98.
AMA	BEKAR L,ÇELEBİ S Hipertansif Hastalarda Fragmente QRS ve Sol Ventrikül Geometrisi. . 2013; 93 - 98.
Vancouver	BEKAR L,ÇELEBİ S Hipertansif Hastalarda Fragmente QRS ve Sol Ventrikül Geometrisi. . 2013; 93 - 98.
IEEE	BEKAR L,ÇELEBİ S "Hipertansif Hastalarda Fragmente QRS ve Sol Ventrikül Geometrisi." , ss.93 - 98, 2013.
ISNAD	BEKAR, Lütfü - ÇELEBİ, Savaş A. "Hipertansif Hastalarda Fragmente QRS ve Sol Ventrikül Geometrisi". (2013), 93-98.

APA	BEKAR L, ÇELEBİ S (2013). Hipertansif Hastalarda Fragmente QRS ve Sol Ventrikül Geometrisi. Koşuyolu Heart Journal, 16(2), 93 - 98.
Chicago	BEKAR Lütfü,ÇELEBİ Savaş A Hipertansif Hastalarda Fragmente QRS ve Sol Ventrikül Geometrisi. Koşuyolu Heart Journal 16, no.2 (2013): 93 - 98.
MLA	BEKAR Lütfü,ÇELEBİ Savaş A Hipertansif Hastalarda Fragmente QRS ve Sol Ventrikül Geometrisi. Koşuyolu Heart Journal, vol.16, no.2, 2013, ss.93 - 98.
AMA	BEKAR L,ÇELEBİ S Hipertansif Hastalarda Fragmente QRS ve Sol Ventrikül Geometrisi. Koşuyolu Heart Journal. 2013; 16(2): 93 - 98.
Vancouver	BEKAR L,ÇELEBİ S Hipertansif Hastalarda Fragmente QRS ve Sol Ventrikül Geometrisi. Koşuyolu Heart Journal. 2013; 16(2): 93 - 98.
IEEE	BEKAR L,ÇELEBİ S "Hipertansif Hastalarda Fragmente QRS ve Sol Ventrikül Geometrisi." Koşuyolu Heart Journal, 16, ss.93 - 98, 2013.
ISNAD	BEKAR, Lütfü - ÇELEBİ, Savaş A. "Hipertansif Hastalarda Fragmente QRS ve Sol Ventrikül Geometrisi". Koşuyolu Heart Journal 16/2 (2013), 93-98.