Hipertansif Hastalarda Sol Ventrikül Hipertrofisini Öngörmede Yeni Bir Elektrokardiyografik Parametre: Ventriküler Aktivasyon Zamanı

Yıl 2026, Cilt: 8 Sayı: 1, 75 - 84, 28.02.2026

Mucahit Yetim , Macit Kalçık , Lütfü Bekar , Muhammet Cihat Çelik

https://doi.org/10.52827/hititmedj.1774845

https://izlik.org/JA66MH72MH

Öz

Amaç: Hipertansiyon hastalarında elektrokardiyografik parametreler ile sol ventrikül hipertrofisi (SVH) arasındaki ilişkinin araştırılması ve özellikle ventriküler aktivasyon zamanının (VAT) tanısal değerinin değerlendirilmesi amaçlandı.
Gereç ve Yöntem: Esansiyel hipertansiyonu olan 320 hasta (ortalama yaş 61,9±7,8 yıl, %57,5 erkek) çalışmaya dahil edildi. Tüm hastalara transtorasik ekokardiyografi ve 12 derivasyonlu yüksek çözünürlüklü EKG çekildi. Hastalar ekokardiyografide SVH varlığına göre iki gruba ayrıldı. Demografik, laboratuvar, ekokardiyografik ve elektrokardiyografik parametreler karşılaştırıldı. Çok değişkenli lojistik regresyon ve ROC analizleri ile bağımsız öngördürücü parametreler belirlendi.
Bulgular: Hastaların 114’ünde (%35,6) SVH saptandı. SVH (+) grupta sol atriyum çapı, interventriküler septal kalınlık, arka duvar kalınlığı, sol ventrikül kütlesi ve kitle indeksi anlamlı olarak daha yüksekti (tümü p<0,001). Elektrokardiyografik parametrelerde P dalgası süresi (p=0,024), QRS süresi (p=0,009) ve VAT (p<0,001) SVH (+) grupta anlamlı derecede uzundu. Çok değişkenli analizde VAT (RR: 2,872; %95 GA: 1,151–7,169; p=0,021), sol ventrikül kütlesi (p=0,017) ve kitle indeksi (p=0,026) SVH için bağımsız öngördürücü bulundu. VAT ile sol ventrikül kütlesi arasında orta düzeyde pozitif korelasyon saptandı (r=0,594; p<0,001). ROC analizinde VAT >30 ms için %67 duyarlılık ve %59 özgüllük elde edildi (AUC=0,681; p<0,001).
Sonuç: Hipertansif hastalarda VAT, sol ventrikül hipertrofisini öngörmede bağımsız bir parametredir. Kolay ölçülebilir ve ek maliyet gerektirmemesi nedeniyle, ekokardiyografiye ek olarak klinik uygulamada kullanılabilecek pratik bir belirteçtir. Daha geniş ve çok merkezli çalışmalarla tanısal ve prognostik değerinin doğrulanması gerekmektedir.

Anahtar Kelimeler

Hipertansiyon , Sol ventrikül hipertrofisi , Ventriküler aktivasyon zamanı , Elektrokardiyografi , Ekokardiyografi

Etik Beyan

Çalışma protokolü, Helsinki Bildirgesi ve İyi Klinik Uygulamalar kılavuzlarına dayanarak 15/11/2018 tarihinde Kartal Kosuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu’ndan onay alınmıştır (Karar no: 2018.8/8-139). Tüm hastalardan yazılı bilgilendirilmiş onam ve yayın için izin alınmıştır.

Destekleyen Kurum

Bu çalışma için herhangi bir finansal destek alınmamıştır.

Teşekkür

Çalışmamızın yapıldığı kliniğimizdeki çalışma arkadaşlarıma özel teşekkür ederiz.

A Novel Electrocardiographic Parameter for Predicting Left Ventricular Hypertrophy in Hypertensive Patients: Ventricular Activation Time

https://izlik.org/JA66MH72MH

Öz

Objective: The aim of this study was to investigate the relationship between electrocardiographic parameters and left ventricular hypertrophy (LVH) in patients with hypertension, and to evaluate the diagnostic value of ventricular activation time (VAT).
Material and Method: A total of 320 patients with essential hypertension (mean age 61.9±7.8 years, 57.5% male) were enrolled. All patients underwent transthoracic echocardiography and 12-lead high-resolution electrocardiography. Patients were divided into two groups according to the presence of LVH on echocardiography. Demographic, laboratory, echocardiographic, and electrocardiographic parameters were compared. Independent predictors were determined using multivariate logistic regression and ROC curve analysis.
Results: LVH was detected in 114 patients (35.6%). The LVH (+) group had significantly larger left atrial diameter, interventricular septal thickness, posterior wall thickness, left ventricular mass, and mass index (all p<0.001). Electrocardiographically, P-wave duration (p=0.024), QRS duration (p=0.009), and VAT (p<0.001) were significantly longer in the LVH (+) group. In multivariate analysis, VAT (RR: 2.872; 95% CI: 1.151–7.169; p=0.021), left ventricular mass (p=0.017), and mass index (p=0.026) were identified as independent predictors of LVH. VAT showed a moderate positive correlation with left ventricular mass (r=0.594; p<0.001). ROC analysis demonstrated that VAT >30 ms predicted LVH with 67% sensitivity and 59% specificity (AUC=0.681; p<0.001).
Conclusion: VAT is an independent predictor of left ventricular hypertrophy in hypertensive patients. Due to its ease of measurement and lack of additional cost, VAT may serve as a practical parameter in clinical practice alongside echocardiography. Larger, multicenter studies are warranted to further validate its diagnostic and prognostic value.

Anahtar Kelimeler

Hypertension , Left ventricular hypertrophy , Ventricular activation time , Electrocardiography , Echocardiography

Etik Beyan

Approval for the study was obtained from the Kartal Kosuyolu High Specialization Training and Research Hospital Non-Interventional Clinical Research Ethics Committee on 15/11/2018 (Decision no: 2018.8/8-139) based on the Declaration of Helsinki and Good Clinical Practice guidelines . Written informed consent and permission for publication were obtained from all patients.

Destekleyen Kurum

No financial funding was received for this study.

Teşekkür

We would like to extend our special thanks to our colleagues in the clinic where our study was conducted

Kaynakça

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