İskemik kalp yetmezliği olan hastalarda tekrar hastaneye yatış için Selvester QRS skorunun prognostik değeri

Öz

Amaç: 12 derivasyonlu elektrokardiyogramda Selvester QRS skorunun miyokardiyal skarla ilgili çeşitli kardiyak olaylardaki prognostik etkileri bilinmektedir. Ayrıca, Selvester QRS skor sisteminin otopsi ile ölçülen miyokardiyal skar boyutu ile de yüksek derecede korelasyona sahip gösterilmiştir. Bu çalışmada, Selvester QRS skorunun iskemik kalp yetmezliğine bağlı yeniden hastaneye yatışı öngörmedeki rolünü değerlendirmeyi amaçladık. Yöntemler: İskemik kalp yetmezliği olan elli dört hastanın verileri geriye dönük olarak incelendi. Hastaneye başvuru sırasındaki EKG’ler temel alınarak Selvester QRS skorları hesaplandı. Birincil son nokta, ilk 3 ay içindeki yeniden hastaneye yatış kabul edildi. Bulgular: Çalışma popülasyonunda, ortalama yaşın 62,1 yıl, sol ventrikül ejeksiyon fraksiyonun (LVEF) %29(6), plazma beyin natriüretik peptit seviyesin (NT-proBNP) 2830 pg / mL olduğu görüldü. Çalışma boyunca 21 hastaneye yeniden yatış gözlendi. Yeniden hastaneye yatırılan hasta grubunda Selvester skoru, diğer gruba göre anlamlı olarak daha yüksekti (5,6'ya karşı 3,3 P=0,01). Cox orantısal risk regresyon analizi, Selvester QRS skorunun yeniden hastaneye yatış için bağımsız bir belirleyici olduğunu ortaya koydu (HR, 1.12; %95 güven aralığı, 0,95-1,34; P=0,04). En iyi cut-off değeri %65 duyarlılık ve %49 özgüllük ile 4,3 puan olarak belirlendi (eğri altındaki alan, 0,618, P=0,02). Ayrıca Selvester QRS skoru ile NT-proBNP arasında anlamlı pozitif korelasyon (r=0,33, P=0,03) ve Selvester QRS skoru ile LVEF arasında negatif korelasyon saptandı (r=-0,67, P=0,04). Sonuç: Bulgularımız, başvuru anındaki Selvester QRS skorunun iskemik kalp yetmezliğine bağlı yeniden hastaneye yatışın bir öngörücü olarak kullanılabileceğini düşündürmektedir.

Anahtar Kelimeler

• Kalp yetersizliği
• Yeniden hastaneye yatış
• Selvester QRS Skoru

Prognostic value of the Selvester QRS score for re-hospitalization in patients with ischemic heart failure

Abstract

Aim: The Selvester QRS score (SSc) on surface electrocardiogram (ECG) has prognostic value in various cardiac events related to myocardial scarring. Furthermore, the SSc system has been validated by post-mortem studies. In this cohort, we assessed the utility of the SSc system for prediction of re-hospitalization in patients with ischemic heart failure (HF). Methods: In this retrospective cohort study, the data of fifty-four consecutive patients with ischemic HF were analyzed. ECGs were collected at first day of admission and SScs were calculated. The primary endpoint was re-hospitalization within the first 3 months. Results: At baseline, the mean age was 62.1 years, LVEF was 29(6) %, NT-proBNP level was 2830 pg/mL. Twenty-one re-hospitalizations were observed due to HF. Patients who were re-hospitalized had significantly higher SScs than those who were not (5.6 vs.3.3 P= 0.01). Cox regression analysis demonstrated that the SSc was an independent predictor of re-hospitalization rate (HR, 1.12; 95% CI, 0.95–1.34; P=0.04). Roc curve analysis showed that SSc was predictive for rehospitalization with a cut-off value 4.3, with a sensitivity of 65% and a specificity of 49% (AUC 0.618, P=0.02). Our analysis indicated a positive correlation between SSc with NT-proBNP and a negative correlation between SSc and LVEF (respectively r=0.33, P=0.03 and r =-0.67, P=0.04). Conclusion: Our results suggest that baseline SSc can be used as a predictor of re-hospitalization due to ischemic HF.

Keywords

• Heart failure
• Re-hospitalization,
• The Selvester QRS Score

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