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Akut Pulmoner Embolili Hastalarda Erken Olumu Ongormede P Dalgası ve QT Dispersiyonlarinin Faydasi

Year 2014, Volume: 15 Issue: 3, 105 - 109, 01.12.2014

Abstract

AMAÇ: Akut pulmoner emboli varlığında P dalgası ve QT dispersiyonlarının erken ölüm ile ilişkisini sorgulamak ve birbiriyle kıyaslamak istedik.GEREÇ VE YÖNTEMLER: Mayıs 2012 ve Haziran 2013 tarihleri arasındaki 124 hastanın arşiv verileri retrospektif olarak analiz edildi. Bunların içinden sinüs ritminde olan ve verileri QT ve P dalga analizlerine uygun olanlar çalışmaya dahil edildi. Her bir hasta için düzeltilmiş QT intervali ve P dalga dispersiyon analizleri yapıldı. BULGULAR: Çalışma grubundaki 12 hasta (%13) ölürken 81 hasta (%87) akut pulmoner emboli tanısı sonrası yaşadı. Ölülerin P dalga dispersiyonu değerleri yaşayanlardan anlamlı olarak daha yüksek saptandı (sırası ile 59.2±21.2 msn’e kıyasla 44.8±13.5 msn, p=0.04). Ayrıca, ölülerin düzeltilmiş QT dsipersiyonu değerleri de yaşayanlardan anlamlı olarak daha yüksek saptandı (sırasıyla 105.5 msn ve 80 msn , p<0.001). P dalga dispersiyonunun >64.5 msn için erken ölümü öngörme sensitivitesi %58,3, spesifitesi %97,5 (p=0.017) olarak bulunurken, düzeltilmiş QT dispersiyonunun >97 msn için erken ölümü öngörme sensitivitesi %83,3, spesifitesi %82,7 olarak bulundu (p<0.001).SONUÇ: Her iki elektrokardiyografi parametresi P dalga dispersiyonu ve QT dispersiyonu iyi ve yararlı markerlar olarak görünmektedir. Bu çalışmada, akut pulmoner emboli seyrinde daha yüksek riskli hastaları ve daha yoğun medikal tedaviye ihtiyacı olanları saptamada, düzeltilmiş QT dispersiyonunun P dalga dispersiyonuna kıyasla daha değerli olduğunu gösterdik

References

  • 1. Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 2008; 29: 2276-315. [CrossRef]
  • 2. Perkiömäki JS, Koistinen MJ, Yli-Mäyry S, Huikuri HV. Dispersion of the QT interval in patients with and without susceptibility to ventricular tachyarrhythmias after previous myocardial infarction. J Am Coll Cardiol 1995; 26: 174-9. [CrossRef]
  • 3. Barr CS, Naas A, Freeman M, Lang CC, Struthers AD. QT dispersion and sudden unexpected death in chronic heart failure. Lancet 1994; 343: 327-9. [CrossRef]
  • 4. Ichkhan K, Molnar J, Somberg J. Relation of left ventricular mass and QT dispersion in patients with systematic hypertension. Am J Cardiol 1997; 79: 508-11. [CrossRef]
  • 5. Hong-liang Z, Qin L, Zhi-hong L, et al. Heart rate-corrected QT interval and QT dis-persion in patties with pulmonary hypertension. Wien KlinWochenschr 2009; 121: 330-3. [CrossRef]
  • 6. Ermıs N, Ermıs H, Sen N, Kepez A, Cuglan B. QT dispersion in patients with pulmonary embolism. Wien KlinWochenschr 2010; 122: 691-7. [CrossRef]
  • 7. Nussinovitch N, Livneh A, Katz K, et al. P wave dis-persion in familial Mediterranean fever. Rheumatol Int 2011; 31: 1591-4. [CrossRef]
  • 8. Michelucci A, Bagliani G, Colella A, et al. P wave assessment: State of the art update. Card Electrophysiol Rev 2002; 6: 215-20. [CrossRef]
  • 9. Kurt M, Tanboğa IH, Karakaş MF, et al. The relationship between atrial electromechanical delay and P-wavedispersion with the presence and severity of metabolic syndrome. Turk Kardiyol Dern Ars 2012; 40: 663-70. [CrossRef]
  • 10. Medford AR. Arrhythmias in COPD: consider P-wavedispersion and pulmonary hypertension, too. Chest 2013; 143: 579. [CrossRef]
  • 11. Sap F, Karataş Z, Altin H, et al. Dispersion durations of P-wave and QT interval in children with congenital heart disease and pulmonary arterial hypertension. Pediatr Cardiol 2013; 34: 591-6. [CrossRef]
  • 12. Bazett HC. An analysis of the time-relations of electrocardiograms. Heart 1920; 7: 353-70.
  • 13. ten Wolde M, Söhne M, Quak E, Mac Gillavry M, Büller HR. Prognostic value of echocardiographically assessed right ventricular dysfunction in patients with pulmonary embolism. Arch Intern Med 2004; 164: 1685-9. [CrossRef]
  • 14. Zabel M, Portnoy S, Franz MR. Electrocardiographic indexes of dispersion of ventricular repolarization: an isolated heart validation study. J Am Coll Cardiol 1995; 25: 746-52. [CrossRef]
  • 15. Hong-liang Z, Qin L, Zhi-hong L, et al. Heart rate-corrected QT interval and QT dispersion in patients with pulmonary hypertension. Wien Klin Wochenschr 2009; 121: 330-3. [CrossRef]
  • 16. Sap F, Karataş Z, Altin H, et al. Dispersion durations of P-wave and QT interval in children with congenital heart disease and pulmonary arterial hypertension. Pediatr Cardiol 2013; 34: 591-6. [CrossRef]
  • 17. Day CP, McComb M, Matthews J, Campbell RW. Reduction in QT dispersion by sotalol following myocar-dial infarction. Eur Heart J 1991; 12: 423-7.
  • 18. Dogan U, Dogan EA, Tekinalp M, et al. P-wave dispersion for predicting paroxysmal atrial fibrillation in acute ischemic stroke. Int J Med Sci 2012; 9: 108-14. [CrossRef]
  • 19. HashemiJazi M, Amirpour A, Zavvar R, Behjati M, Gharipour M. Predictive value of P-wave duration and dispersion in post coronary artery bypass surgery atrial fibrillation. ARYA Atheroscler 2012; 8: 59-62.
  • 20. Barra SN, Paiva LV, Providência R, Fernandes A, Leitão Marques A. Atrial fibrillation in acute pulmonary embolism: prognostic considerations. Emerg Med J 2014; 31: 308-12. [CrossRef]
  • 21. Elmoniem AA, El-Hefny N, Wadi W. P Wave Dispersion (PWD) as a predictor of Atrial Fibrillation (AF). Int J Health Sci (Qassim) 2011; 5(2 Suppl 1): 25-6.

Usefullness of P-wave and QT Dispersions for Predicting Early Death in Patients with Acute Pulmonary Embolism

Year 2014, Volume: 15 Issue: 3, 105 - 109, 01.12.2014

Abstract

OBJECTIVE: We aimed to demonstrate and compare to each other the relations of QT and P wave dispersions with early death in the course of acute pulmonary embolism (PE). MATERIALS AND METHODS: The archive data of 124 patients who had been hospitalized in our hospital with the diagnosis of acute PE between May 2012 and June 2013 was retrospectively reviewed. 93 patients who were in sinus rhythm and whose data were suitable for QT interval and P wave analyses were included to the study. Analyses of corrected QT interval dispersion (QTcd) and P wave dispersion (Pd) were performed for each patients. RESULTS: Among the study population, 12 patients (13%) died and 81 patients (87%) lived after the diagnosis of PE. PD values of deaths were significantly higher than those who survived (59.2±21.2 msec versus 44.8±13.5 msec respectively, p=0.04). Moreover, QTcd values of deaths were also significantly higher than the survivors (105.5 msec (99-119) versus 80msec (74-88) respectively, p<0.001). The sensitivity of Pd>64.5 msec for prediction of early mortality was found to be 58.3% with a specificity of 97.5% (p=0.017) where the sensitivity of Qtcd> 97  msec for prediction of early mortality was found to be  83.3% with a specificity of 82.7% (p<0.001). CONCLUSION: Both electrocardiography parameters Pd and QTcd may be used as a good and useful markers. We found that, in comparison to Pd, QTcd is superior to detect those who were under potential high risk and who need more aggressive treatment in the course of acute PE.

References

  • 1. Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 2008; 29: 2276-315. [CrossRef]
  • 2. Perkiömäki JS, Koistinen MJ, Yli-Mäyry S, Huikuri HV. Dispersion of the QT interval in patients with and without susceptibility to ventricular tachyarrhythmias after previous myocardial infarction. J Am Coll Cardiol 1995; 26: 174-9. [CrossRef]
  • 3. Barr CS, Naas A, Freeman M, Lang CC, Struthers AD. QT dispersion and sudden unexpected death in chronic heart failure. Lancet 1994; 343: 327-9. [CrossRef]
  • 4. Ichkhan K, Molnar J, Somberg J. Relation of left ventricular mass and QT dispersion in patients with systematic hypertension. Am J Cardiol 1997; 79: 508-11. [CrossRef]
  • 5. Hong-liang Z, Qin L, Zhi-hong L, et al. Heart rate-corrected QT interval and QT dis-persion in patties with pulmonary hypertension. Wien KlinWochenschr 2009; 121: 330-3. [CrossRef]
  • 6. Ermıs N, Ermıs H, Sen N, Kepez A, Cuglan B. QT dispersion in patients with pulmonary embolism. Wien KlinWochenschr 2010; 122: 691-7. [CrossRef]
  • 7. Nussinovitch N, Livneh A, Katz K, et al. P wave dis-persion in familial Mediterranean fever. Rheumatol Int 2011; 31: 1591-4. [CrossRef]
  • 8. Michelucci A, Bagliani G, Colella A, et al. P wave assessment: State of the art update. Card Electrophysiol Rev 2002; 6: 215-20. [CrossRef]
  • 9. Kurt M, Tanboğa IH, Karakaş MF, et al. The relationship between atrial electromechanical delay and P-wavedispersion with the presence and severity of metabolic syndrome. Turk Kardiyol Dern Ars 2012; 40: 663-70. [CrossRef]
  • 10. Medford AR. Arrhythmias in COPD: consider P-wavedispersion and pulmonary hypertension, too. Chest 2013; 143: 579. [CrossRef]
  • 11. Sap F, Karataş Z, Altin H, et al. Dispersion durations of P-wave and QT interval in children with congenital heart disease and pulmonary arterial hypertension. Pediatr Cardiol 2013; 34: 591-6. [CrossRef]
  • 12. Bazett HC. An analysis of the time-relations of electrocardiograms. Heart 1920; 7: 353-70.
  • 13. ten Wolde M, Söhne M, Quak E, Mac Gillavry M, Büller HR. Prognostic value of echocardiographically assessed right ventricular dysfunction in patients with pulmonary embolism. Arch Intern Med 2004; 164: 1685-9. [CrossRef]
  • 14. Zabel M, Portnoy S, Franz MR. Electrocardiographic indexes of dispersion of ventricular repolarization: an isolated heart validation study. J Am Coll Cardiol 1995; 25: 746-52. [CrossRef]
  • 15. Hong-liang Z, Qin L, Zhi-hong L, et al. Heart rate-corrected QT interval and QT dispersion in patients with pulmonary hypertension. Wien Klin Wochenschr 2009; 121: 330-3. [CrossRef]
  • 16. Sap F, Karataş Z, Altin H, et al. Dispersion durations of P-wave and QT interval in children with congenital heart disease and pulmonary arterial hypertension. Pediatr Cardiol 2013; 34: 591-6. [CrossRef]
  • 17. Day CP, McComb M, Matthews J, Campbell RW. Reduction in QT dispersion by sotalol following myocar-dial infarction. Eur Heart J 1991; 12: 423-7.
  • 18. Dogan U, Dogan EA, Tekinalp M, et al. P-wave dispersion for predicting paroxysmal atrial fibrillation in acute ischemic stroke. Int J Med Sci 2012; 9: 108-14. [CrossRef]
  • 19. HashemiJazi M, Amirpour A, Zavvar R, Behjati M, Gharipour M. Predictive value of P-wave duration and dispersion in post coronary artery bypass surgery atrial fibrillation. ARYA Atheroscler 2012; 8: 59-62.
  • 20. Barra SN, Paiva LV, Providência R, Fernandes A, Leitão Marques A. Atrial fibrillation in acute pulmonary embolism: prognostic considerations. Emerg Med J 2014; 31: 308-12. [CrossRef]
  • 21. Elmoniem AA, El-Hefny N, Wadi W. P Wave Dispersion (PWD) as a predictor of Atrial Fibrillation (AF). Int J Health Sci (Qassim) 2011; 5(2 Suppl 1): 25-6.
There are 21 citations in total.

Details

Other ID JA69TN52AY
Journal Section Research Article
Authors

Çağdaş Akgüllü This is me

Ufuk Eryılmaz This is me

Evrin Dağtekin This is me

Mehmet Akdeniz This is me

Hasan Güngör This is me

Cemil Zencir This is me

İmran Kurt Ömürlü This is me

Publication Date December 1, 2014
Published in Issue Year 2014 Volume: 15 Issue: 3

Cite

EndNote Akgüllü Ç, Eryılmaz U, Dağtekin E, Akdeniz M, Güngör H, Zencir C, Kurt Ömürlü İ (December 1, 2014) Usefullness of P-wave and QT Dispersions for Predicting Early Death in Patients with Acute Pulmonary Embolism. Meandros Medical And Dental Journal 15 3 105–109.