Stabil Koroner Arter Rahatsızlığı Olan Hastalarda Erken Repolarizasyon Patern Varlığı ile Koroner Arter Hastalığının Ciddiyeti Arasındaki İlişki

Year 2019, , 113 - 119, 20.03.2019

Serhat Karaman , Kayıhan Karaman , Abuzer Coşkun

https://doi.org/10.31832/smj.524970

Abstract

Amaç: Erken repolarizasyon paterni (ERP) iyi huylu bir
varyant olarak kabul edilmesine rağmen, son zamanlarda yapılan çalışmalarda
hayatı tehdit eden aritmilerle ilişkili olduğu gösterilmiştir. Hayatı tehdit
eden aritmi ve koroner arter hastalığının (KAH) şiddeti arasında güçlü bir
ilişki olduğunu gösteren farklı çalışmalar vardır. Bu çalışmada ERP'li
hastalarda Gensini skoru (GS) değerlerinin ERP'siz hastalara göre daha yüksek
olup olmadığını belirlemeyi amaçladık.

Gereç
ve Yöntemler: Çalışmaya ERP'li toplam 110 hasta
ve 90 kontrol grubu alındı. Her hasta için GS hesaplandı. p< 0.05 anlamlı
kabul edildi.

Bulgular: GS, ERP’li hastalarda kontrol grubuna göre
anlamlı derecede yüksekti (19.5±20.2 ve 2.15±4.1; p <0.001). GS ile yaş
arasında anlamlı ilişki vardı (r= 0.507, p< 0.001). GS, çok değişkenli
lojistik regresyon analizinde bağımsız bir ERP belirleyicisidir (OR= 0.655,% 95
CI= 0.557-0.769, p <0.001). Ek olarak, yaş ve düşük yoğunluklu lipoprotein
kolesterolü, lineer regresyon analizinde GS ile ilişkili bağımsız öngörücülerdi
(OR= 0.370,%95 CI= 0.085-0.655, p= 0.011 ve OR= -0.094,%95 CI= (-0.176 -0.013),
sırasıyla p= 0.024).

Sonuçlar: KAH'nın ciddiyetindeki artış, ERP'nin ortaya
çıkmasına yol açan bir mekanizma olarak gösterilebilir.

Keywords

Erken repolarizasyon patern; Gensini skoru; Stabil Koroner Arter Hastalığı

The Relationship Between the Presence of Early Repolarization Pattern and the Severity of Coronary Artery Disease in Patients with Stable Coronary Artery Disease

Abstract

Objective:
Although early repolarization pattern (ERP) has been recognized as a benign
variant, in recent studies have shown that it is associated with
life-threatening arrhythmias. There are different studies demonstrated that
there is a strong relationship between life-threatening arrhythmias and the
severity of coronary artery disease (CAD). In this study, we aimed to determine
whether Gensini score (GS) values were higher in patients with ERP compared to
patients without ERP.

Materials
and Methods: Totally 110 patients with ERP and 90 control subjects were
enrolled to the study. GS was calculated for each patient. p values < 0.05
were considered significant.

Results:
GS was significantly higher in the ERP patients compared with the control group
(19.5±20.2 vs 2.15±4.1; p<0.001). There was significant correlation between
GS and age (r=0.507, p<0.001). GS was an independent predictor of ERP in
multivariate logistic regression analysis (OR=0.655, 95% CI=0.557-0.769,
p<0.001). In addition to, age and low-density lipoprotein cholesterol were
independent predictors associated with GS in linear regression analysis
(OR=0.370, 95% CI=0.085-0.655, p=0.011 and OR= -0.094, 95% CI= (-0.176-0.013),
p=0.024, respectively).

Conclusions:
An increase in the severity of CAD may be shown as a mechanism that leads to
the emergence of ERP.

Keywords

Early repolarization pattern; Gensini score; Stable Coronary Artery Disease

References

• 1. Macfarlane PW, Antzelevitch C, Haissaguerre M, Huikuri HV, Potse M, Rosso R, et al. The early repolarization pattern: A Consensus Paper. J Am Coll Cardiol. 2015;66:470-477.
• 2. Klatsky AL, Oehm R, Cooper RA, Udaltsova N, Armstrong MA. The early repolarization normal variant electrocardiogram: Correlates and consequences. Am J Med. 2003;115:171-177.
• 3. Haïssaguerre M, Derval N, Sacher F, Jesel L, Deisenhofer I, de Roy L, et al. Sudden cardiac arrest associated with early repolarization. N Engl J Med. 2008;358:2016-2023.
• 4. Rosso R, Kogan E, Belhassen B, Rozovski U, Scheinman MM, Zeltser D, et al. J-point elevation in survivors of primary ventricular fibrillation and matched control subjects: Incidence and clinical signifcance. J Am Coll Cardiol. 2008;52:1231-1238.
• 5. Patel RB, Ilkhanoff L, Ng J, Chokshi M, Mouchli A, Chacko SJ, et al. Clinical characteristics and prevalence of early repolarization associated with ventricular arrhythmias following acute ST elevation myocardial infarction. Am J Cardiol. 2012;110:615-620.
• 6. Rudic B, Veltmann C, Kuntz E, Behnes M, Elmas E, Konrad T, et al. Early repolarization pattern is associated with ventricular fibrillation in patients with acute myocardial infarction. Heart Rhythm. 2012;9:1295-1300.
• 7. Ali Diab O, Abdel-Hafez Allam RM, Mohamed HG, Mohamed TR, Abel-Hafeez Khalid S. Early repolarization pattern is associated with increased risk of early ventricular arrhythmias during acute ST segment elevation myocardial infarction. Ann Noninvasive Electrocardiol. 2015;20:474-480.
• 8. Taşolar H, Ballı M, Çetin M, Otlu YÖ, Altun B, Bayramoğlu A. Effects of the coronary collateral circulation on the Tp-e interval and Tp-e/QT ratio in patients with stable coronary artery disease. Ann Noninvasive Electrocardiol. 2015;20(1):53-61.
• 9. Cetin M, Zencir C, Cakici M, Yildiz E, Tasolar H, Balli M, et al. Effect of a successful percutaneous coronary intervention for chronic total occlusion on parameters of ventricular repolarization. Coron Artery Dis. 2014;25(8):705-712.
• 10. Gensini GG. The coronary artery disease scoring and retrieval system of Gensini. In: Gensini GG, Editor. Coronary arteriography. New York, NY: Futura Pub. Co.;1975. p.271-274.
• 11. Miyazaki S, Shah AJ, Haïssaguerre M. Early repolarization syndrome – a new electrical disorder associated with sudden cardiac death –. Circ J. 2010;74(10):2039-2044.
• 12. Gussak I, Antzelevitch C. Early repolarization syndrome: clinical characteristics and possible cellular and ionic mechanisms. J Electrocardiol. 2000;33:299-309.
• 13. Shu J, Zhu T, Yang L, Cui C, Yan GX. ST-segment elevation in the early repolarization syndrome, idiopathic ventricular fibrillation, and the Brugada syndrome: cellular and clinical linkage. J Electrocardiol. 2005;38:26-32.
• 14. Furukawa Y, Yamada T, Morita T, Iwasaki Y, Kawasaki M, Kikuchi A, et al. Early repolarization pattern associated with sudden cardiac death: long-term follow up in patients with chronic heart failure. J Cardiovasc Electrophysiol. 2013;24:632-639.
• 15. Benito B, Guasch E, Rivard L, Nattel S. Clinical and mechanistic issues in early repolarization of normal variants and lethal arrhythmia syndromes. J Am Coll Cardiol. 2010;56:1177-1186.
• 16. Takagi M, Aihara N, Takaki H, Taguchi A, Shimizu W, Kurita T, et al. Clinical characteristics of patients with spontaneous or inducible ventricular fibrillation without apparent heart disease presenting with J wave and ST segment elevation in inferior leads. J Cardiovasc Electrophysiol. 2000;11:844-848.
• 17. Naruse Y, Tada H, Harimura Y, Hayashi M, Noguchi Y, Sato A, et al. Early repolarization is an independent predictor of occurrences of ventricular fibrillation in the very early phase of acute myocardial infarction. Circ Arrhythm Electrophysiol. 2012;5:506-513.
• 18. Thenappan T, Ali Raza J, Movahed A. Aortic atheromas: current concepts and controversies-a review of the literature. Echocardiography. 2008;25:198-207.
• 19. Laurent S, Cockcroft J, Van Bortel L, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006;27:2588-2605.
• 20. Antzelevitch C. T peak-T end interval as an index of transmural dispersion of repolarization. Eur J Clin Invest. 2001;31:555-557.
• 21. Karaman K, Karayakali M, Arisoy A, Akar I, Ozturk M, Yanik A, et al. Is There any Relationship Between Myocardial Repolarization Parameters and the Frequency of Ventricular Premature Contractions? Arq Bras Cardiol. 2018;110(6):534-541.
• 22. Zareba W, Moss AC, le Cessie S. Dispersion of ventricular repolarization and arrhythmic cardiac death in coronary artery disease. Am J Cardiol. 1994;74:550-553.
• 23. Goodhart DM, Hubacek J, Anderson TJ, Duff H, Barbeau G, Ducas J, et al. TOSCA investigators. Effect of percutaneous coronary intervention of nonacute total coronary artery occlusions on QT dispersion. Am Heart J. 2006;151:529.e1-529.e6.
• 24. Antzelevitch C, Yan GX, Ackerman MJ, Borggrefe M, Corrado D, Guo J, et al. J-wave syndromes expert consensus conference report: emerging concepts and gaps in knowledge. J Arrhythm. 2016;32(5):315-339.
• 25. Tsuda T, Hayashi K, Konno T, Sakata K, Fujita T, Hodatsu A, et al. J waves for predicting cardiac events in hypertrophic cardiomyopathy. JACC Clin Electrophysiol. 2017;3(10):1136-1142.
• 26. Tikkanen JT, Wichmann V, Junttila MJ, Rainio M, Hookana E, Lappi OP, et al. Association of early repolarization and sudden cardiac death during an acute coronary event. Circ Arrhythm Electrophysiol. 2012;5:714¬-718.
• 27. Antzelevitch C, Yan GX. J wave syndromes. Heart Rhythm. 2010;7:549-558.