Kardiyak Sendrom X Tanılı Hastalarda Artmış Ventriküler Aktivasyon Zamanı

Year 2019, Volume: 22 Issue: 3, 145 - 151, 24.12.2019

Macit Kalçık Emrah Bayam Ahmet Güner Mahmut Yesin Mücahit Yetim Tolga Doğan Lütfü Bekar Oğuzhan Çelik Yusuf Karavelioğlu

Abstract

Giriş: Kardiyak sendrom X (KSX) noninvaziv stres testlerinde tespit edilebilen iskemi olmasına rağmen koroner anjiyografide koroner arter stenozu bulgularının olmadığı tipik anjina olarak tanımlanmaktadır. Bozulmuş koroner mikrosirkülasyon, inflamasyon ve endotel disfonksiyonu KSX için kabul edilmiş etyolojik faktörlerdir. Ventriküler aktivasyon zamanının (VAZ) miyokardiyal iskemi durumunda Purkinje liflerinde ve miyositlerdeki iletim yavaşlamasına bağlı olarak uzadığı bildirilmiştir. Bu çalışmada, KSX hastalarında aralarında VAZ’ın da bulunduğu elektrokardiyografik parametrelerin araştırılması amaçlanmıştır.

Hastalar ve Yöntem: Çalışmaya KSX tanısı alan 120 hasta (ortalama yaş: 54.7 ± 8.6 yıl , erkek: 53) ile iskemisi olmayan 130 sağlıklı kontrol (ortalama yaş: 53.3 ± 8.9 yıl , erkek: 66) dahil edildi. Tüm hastalar elektrokardiyografi ve transtorasik ekokardiyografi ile değerlendirildi. VAZ elektrokardiyografide QRS kompleksinin başlangıcından R veya R’ dalgasının zirvesine kadar geçen zaman aralığı olarak tanımlandı.

Bulgular: KSX hastaları ile kontrol grubu arasında demografik, laboratuvar ve ekokardiyografik parametreler açısından anlamlı bir fark izlenmedi. Elektrokardiyografik parametreler karşılaştırıldığında gruplar arasında kalp hızı, P dalga süresi, PR aralığı, QT ve düzeltilmiş QT aralığı açısından anlamlı fark yok iken, QRS süresi (95.1 ± 13.8 ve 90.4 ± 12.7 msn, p= 0.006) ve VAZ (34.8 ± 5.7 ve 29.2 ± 5.6 msn, p< 0.001) KSX grubunda anlamlı olarak daha uzun olarak tespit edildi.

Sonuç: Bu çalışmada KSX hastalarında QRS süresi ve VAZ’ın anlamlı olarak uzadığı gösterilmiştir. Bu uzama KSX hastalarındaki bozulmuş mikrovasküler perfüzyon ve iskemiye bağlı iletim yavaşlamasına bağlı gelişmiş olabilir.

Increased Ventricular Activation Time in Patients with the Diagnosis of Cardiac Syndrome X

Abstract

Introduction: Cardiac syndrome X (CSX) is defined as typical angina with detectable ischaemia on noninvasive stress tests without any evidence of coronary artery stenosis during coronary angiography. Impaired coronary microcirculation, inflammation and endothelial dysfunction are accepted aetiological factors for CSX. The ventricular activation time (VAT) has been reported to be prolonged in myocardial ischaemia due to the conduction delay in the Purkinje fibres and the myocytes. In this study, we aimed to investigate the electrocardiographic parameters including VAT in patients with CSX.

Patients and Methods: This study enrolled 120 patients (mean age, 54.7 ± 8.6 years; male, 53) diagnosed with CSX and 130 healthy controls (mean age, 53.3 ± 8.9; male, 66) without ischaemia. All patients underwent electrocardiography and transthoracic echocardiography. VAT was defined as the interval from the beginning of the QRS complex until the peak of the R or R’ wave.

Results: There was no significant difference in terms of demographic, laboratory and echocardiographic parameters between CSX patients and controls. Comparison of electrocardiographic parameters yielded that there was no significant difference in terms of the heart rate, P-wave duration, PR interval, QT and corrected QT intervals between the groups. However, the QRS duration (95.1 ± 13.8 vs. 90.4 ± 12.7 msec; p= 0.006) and VAT (34.8 ± 5.7 vs. 29.2 ± 5.6 msec; p< 0.001) were significantly higher in patients with CSX.

Conclusion: The present study demonstrated that QRS duration and VAT were prolonged significantly in patients with CSX. This prolongation may be due to the presence of impaired microvascular perfusion and ischaemia-induced conduction delay.

Keywords

Cardiac syndrome X, electrocardiography, ventricular activation time

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