The Predictive Value of P wave Dispersion in Determination of Infarct Ralated Artery Patency

Abstract

Introduction: The value of P-wave dispersion (PWD) on the surface electrocardiogram (ECG) has been shown to increase in coronary ischemia. Previous studies demonstrated that PWD decreased with repefusion therapy in patients with STEMI. The aim of current study is to investigate whether PWD is able to be used as an additional parameter to predict successful reperfusion and infarct related artery patency in patients with STEMI who were admitted in the first 12 hours of myocardial infarction and received thrombolytic therapy.Patients and Methods: A total of 150 patients who referred to Dokuz Eylül University Cardiology Department with STEMI between 01 January 2012 and 01 December 2013 and received thrombolytic therapy in the first 12 hours of the symptoms were included in our study. Hospital records of each patient were evaluated retrospectively. Demographical features were noted. Standart 12-lead surface ECG of each patient which were recorded before and at 30, 60, 90 and 120 minutes after the start of thrombolytic therapy were obtained. Maximum, minimum P-wave duration and PWD were calculated on each electrocardiogram and ST segment resolution was determined. Coronary angiography images were also evaluated to determine TIMI flow grade and TIMI frame count of the infarct related artery. The relationship between PWD and ST segment resolution and infarct related artery patency was investigated.Results: While PWD at the start of the thrombolytic therapy was 50.79±14.12 ms, PWD at 90th minute of thrombolytic therapy was calculated as 48.34±15.60 and PWD at 120th minute of thrombolytic therapy was calculated as 47.85±10.87 ms; the difference was not statistically significant (p= 0.07). The comparison of PWD values with ST segment resolution groups demonstrated that PWD at 120th minute of thrombolytic therapy was found to be significantly lower in complete resolution group than incomplete and inadequate resolution groups (42.10±9.55, 49.65±10.60, 56.08±7.44 ms respectively; p

Keywords

• P-wave dispersion, thrombolytic therapy, STEMI, ST segment resolution

P Dalga Dispersiyonunun İnfarkt İlişkili Aater Açıklığını Saptamadaki Prediktif Değeri

Abstract

Giriş: Yüzey elektrokardiyografi (EKG) ile ölçülen P-dalga dispersiyonu (PDD) değerinin koroner iskemide uzadığı gösterilmiştir. ST elevasyonlu myokard infarktüs (STEMI) hastalarında da reperfüzyon tedavisi ile PDD değerlerinin başlangıç değerlere göre kısaldığı çeşitli çalışmalarla gösterilmiştir. Çalışmamızın amacı; STEMI tanısı ile ilk 12 saatte başvuran ve trombolitik tedavi uygulanan hastalarda, PDD değerinin başarılı reperfüzyonu ve infarkt ilişkili arter açıklığını öngördürmede ek bir parametre olarak kullanılıp kullanılamayacağını belirlemektir.Hastalar ve Yöntem: Çalışmamıza 01.01.2012 – 01.12.2013 tarihleri arasında Dokuz Eylül Üniversitesi Tıp Fakültesi Kardiyoloji AD'na STEMİ tanısıyla başvuran ve semptomların ilk 12 saati içinde trombolitik tedavi uygulanan ardışık 150 hasta alındı. Veriler geriye dönük olarak incelendi. Hastaların demografik özellikleri, rutin laboratuar parametreleri kaydedildi. Trombolitik tedavinin 0, 30, 60, 90 ve 120. dakikalarında çekilen 12 derivasyonlu EKG kayıtlarına ulaşıldı. Tüm EKG'lerde maksimum, minimum P dalga süreleri ve PDD hesaplandı, ST segment rezolüsyon oranları belirlendi. Ayrıca hastaların koroner anjiyografi görüntüleri değerlendirilip infarkt ilişkili arterdeki TIMI kan akımı ve TIMI kare sayısı hesaplandı. PDD değerleri ile ST segment rezolüsyonu ve infarkt ilişkili arter açıklığı arasındaki ilişki değerlendirildi.Bulgular: Trombolitik tedavi başlangıcında ölçülen PDD değeri 50.79±14.12 msn iken 90. dk PDD değeri 48.34±15.60 ve 120. dk'da ölçülen PDD değeri 47.85±10.87 msn olarak saptandı, aradaki fark istatistiksel olarak anlamlı değildi (p= 0.07). PDD değerleri, ST segment rezolüsyon grupları ile karşılaştırıldığında; 120. dk'da ölçülen PDD değerinin komplet rezolüsyon sağlanan grupta, inkomplet ve yetersiz rezolüsyon sağlanan gruplara göre anlamlı olarak daha düşük olduğu saptandı (sırasıyla; 42.10±9.55, 49.65±10.60, 56.08±7.44 msn; p

Keywords

• P-dalga dispersiyonu, trombolitik tedavi, STEMİ, ST segment rezolüsyonu

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