Measurement of The QT Dispersion In Patients With Cardiac Syndrome X For The Investigation of Ischemia As An Etiological Factor

Abstract

Clinical and demographic characteristics of the groups such as age, gender body mass index, systolic and diastolic blood pressure showed no statistically significant differences between both groups. Although there was no difference in QTd values between groups at baseline (43,28 ± 12,55 msec in the positive ETT group, and 40,28 ± 11,08 msec in the control group, p=NS), peak exercise QTd was much higher in the positive ETT group than the control group (57,40 ± 13,70 msec and 28,23 ± 5,05 msec, respectively, p< 0.01). Since QTd greater than 60 msec related to ischemia has been previously reported, ETT positive patients were reevaluated in two different subgroups with QTd ? 60 msec (34 patients), and QTd < 60 msec(32 patients). The sum of ST depression were much more in the QTd ? 60 msec group (7,22 ± 0,74 vs 4,40 ± 1,78; t: -8,458, p

Keywords

• Cardiac syndrome X, QT dispersion, ischemia, exercise treadmill testing.

Kardiyak Sendrom X Hastalarında Etiyolojik Bir Faktör Olarak İskeminin Araştırılmasında QT Dispersiyonu Ölçümü

Abstract

Amaç: Pozitif egzersiz testi ile birlikte angina ya da angina benzeri göğüs ağrısı ve normal koroner anjiografi ile karakterize kardiyak sendrom X'in (KSX) gerçek nedeni tartışmalıdır. QT dispersiyonu (QTd) ölçümü miyokard heterojenitesini gösteren invazif olmayan bir yöntemdir. İskemik miyokardın iskemik olmayan miyokardla repolarizasyon süresi farkı QTd'de uzamaya yol açar. Bu çalışmanın amacı KSX'li hastalarda QTd ölçümü ile etyolojik bir faktör olarak iskemi varlığının araştırılmasıdır. Yöntem: Stabil angina pektorisi olan 105 hasta çalışmaya dahil edildi. Toplam 105 hastanın 66'sı (38 kadın, 28 erkek, ortalama yaş: 48,08±10,21) pozitif egzersiz testi ve normal koroner anjiografi ile KSX olarak teşhis edildi. 39 hastadan oluşan kontrol grubu (24 kadın, 15 erkek, ortalama yaş: 50,84±11,34) ise negatif egzersiz testi ve normal koroner anjiografiye sahipti. QT intervali istirahat ve zirve egzersiz sırasında alınan standart 12 derivasyonlu elektrokardiyografi üzerinden ölçüldü. QTd maksimum

Keywords

• Kardiyak sendrom X, QT dispersiyonu, iskemi, egzersiz treadmill testi.

References

1. Kaski JC. Chest pain with normal coronary angiogram; patho- genesis, diagnosis and management. In Kaski JC (ed): Angina pectoris and normal coronary arteries: syndrome X. 2nd edn. Kluwer Academic Publishers, Boston 1999: 1–12.
2. Ponikowski P, Rosano GM, Amadi AA, Collins P, Coats AJ, Poole-Wilson PA, et al. Transient autonomic dysfunction pre- cedes ST-segment depression in patients with syndrome X. Am J Cardiol 1996;77:42-7.
3. Zeiher AM, Krause T, Schächinger V, Minners J, Moser E. Im- 14Koşuyolu Kalp Dergisi
4. Gökhan Alıcı, MD, paired endothelium-dependent vasodilation of coronary resist- ance vessels is associated with exercise-induced myocardial is- chemia. Circulation 1995;91:2345-52.
5. Frİbert O, Arendt-Nielsen L, Bak P, Funch-Jensen P, Peder Bagger J. Pain perception and brain evoked potentials in patients with angina despite normal coronary angiograms. Heart 1996; 75: 436-41.
6. Stoletniy LN, Pai RG. Usefulness of QTc dispersion in inter- preting exercise electrocardiograms. Am Heart J 1995;130:918- 21.
7. Kautzner J, Malik M. QT interval dispersion and its clinical util- ity. PACE 1997;20:2625-40.
8. Roukema G, Singh JP, Meijs M, Carvalho C, Hart G. Effects of exercise-induced ischemia on QT interval dispersion. Am Heart J 1998;135:88-92.

9. Tomassoni G, Pisanó E, Gardner L, Krucoff MW, Natale A. QT prolongation and dispersion in myocardial ischemia and infarction. J Electrocardiol 1998;30 Suppl:187-90.
10. Stoletniy LN, Pai RG. Value of QT dispersion in the interpreta- tion of exercise stress test in women. Circulation 1997;96:904-10. 10. Koide Y, Yotsukura M, Yoshino H, Ishikawa K. Value of QT dis- persion in the interpretation of treadmill exercise electrocardiograms of patients without exercise-induced chest pain or ST-segment de- pression. Am J Cardiol 2000;85:1094-9.
11. Okin PM, Kligfield P. Gender-specific criteria and performance of the exercise electrocardiogram. Circulation 1995;92:1209-16. 12. Chaitman BR: Exercise stress testing. In Heart Disease, 6th Edi- tion (Eds. Braunwald E, Zipes DP, Libby P), p. 129-159. Philade- phia: W.B. Saunders Co., 2001.
12. Kemp HG Jr. Left ventricular function in patients with the angi- nal syndrome and normal coronary arteriograms. Am J Cardiol 1973;32:375-6.
13. Cannon RO, Camici PG, Epstein SE. Pathophysiological dilemma of syndrome X. Circulation 1992;85:883-92.
14. Camici PG, Marraccini P, Lorenzoni R, Buzzigoli G, Pecori N, Perissinotto A, et al. Coronary hemodynamics and myocardial me- tabolism in patients with syndrome X: response to pacing stress. J Am Coll Cardiol 1991;17:1461-70.
15. Maseri A, Crea F, Kaski JC, Crake T. Mechanisms of angina pectoris in syndrome X. J Am Coll Cardiol 1991;17:499-506.
16. Cannon RO 3rd, Epstein SE. “Microvascular angina” as a cause of chest pain with angiographically normal coronary arteries. Am J Cardiol 1988;61:1338-43.
17. Egashira K, Inou T, Hirooka Y, Yamada A, Urabe Y, Takeshi- ta A. Evidence of impaired endothelium dependent coronary va- sodilatation in patients with angina pectoris and normal coronary angiograms. N Engl J Med 1993;328:1659-64.
18. Kaski JC, Cox ID, Crook JR, Salomone OA, Fredericks S, Hann C, et al. Differential plasma endothelin levels in subgroups of pa- tients with angina and angiographically normal coronary arteries. Am Heart J 1998;136:412-7.
19. Rosen SD, Paulesu E, Wise RJ, Camici PG. Central neural con- tribution to the perception of chest pain in cardiac syndrome X. Heart 2002;87:513-9.
20. Cin VG, Celik M, Ulucan S. QT dispersion ratio in patients with unstable angina pectoris (a new risk factor?). Clin Cardiol 1997; 20: 533-5.
21. Zareba W, Moss AJ, Cessie S. Dispersion of ventricular re- polarization and arrhythmic cardiac death in coronary artery dis- ease. Am J Cardiol 1994;74:550-3.
22. Higham PD, Campbell RW. QT dispersion. Br Heart J. 1994;71:508-10.
23. Struthers AD, Davidson NC, Naas A, Pringle T, Pringle S. QT dispersion and triple-vessel coronary disease. Lancet 1997;349:1174-5.
24. Tomkiewicz-Pajak L, Olszowska M, Przewłocki T, Sedziwy E, Wilkołek P, Tracz W. Changes in QT dispersion during the exercise test in women with syndrome X. Przegl Lek 2001;58:117-9.
25. Mammana C, Salomone OA, Kautzner J, Schwartzman RA, Kaski JC. Heart rate-independent prolongation of QTc interval in women with syndrome X. Clin Cardiol 1997;20:357-60.
26. Kaski JC, Rosano GM, Collins P, Nihoyannopoulos P, Maseri A, Poole-Wilson PA. Cardiac syndrome X: clinical characteristics and left ventricular function. Long-term follow-up study. J Am Coll Cardiol 1995;25:807-14.