Asemptomatik karotid arter stenozunda uzamış atriyal elektromekanik gecikme ve P-dalga parametreleri: invaziv olmayan bir değerlendirmeden yeni görüşler

Abstract

Arka Plan: İnme, gelişmiş toplumlarda ölümün ilk üç nedeninden biridir. İskemik inmeler karotis arter stenozu (KAS) ile bağlantılıdır. Atriyal fibrilasyon (AF), yaygın olarak karşılaşılan bir klinik aritmidir. Atriyal elektromekanik gecikme (EMD) olarak bilinen intratriyal ve interatriyal iletim sürelerinin uzamasının daha yüksek AF riski ile ilişkili olduğu gösterilmiştir. KAS hasta grubunda yüzey elektrokardiyografi ve doku Doppler ekokardiyografi görüntüleme(TDI) ölçümleri arasındaki atriyal iletim anormalliklerinin korelasyonunu belirlemeyi amaçladık. Yöntemler: Çalışmaya ekstrakraniyal internal karotis arter (IKA) stenozu tanısı almış 76 hasta dahil edildi. Asemptomatik ciddi KAS, karotis dijital subtraction anjiyografisi (DSA) ile %60-99 stenoz tespit edilen hastalar olarak tanımlandı. En uzun P dalgası ve en uzun atriyal iletim süresi (ACT), maksimum P dalgası süresi olarak kabul edildi. En uzun P dalgası (Pmax) ile en kısa P dalgası (Pmin) arasındaki fark PD olarak kabul edildi. (PD=Pmax-Pmin). Atriyal EMD, atriyal elektriksel aktivitenin başlangıcından mekanik atriyal kasılmanın başlangıcına kadar geçen zaman aralığı olarak tanımlandı. Sonuçlar: KAS grubunda Pmax ve PD değerleri kontrol grubuna kıyasla anlamlı derecede daha uzundu (Pmax 104,72±6,03 ve 93,06±7,26 ms, p<0,001; PD 48,55±6,72 ve 38,50±8,12 ms, p<0,001). TDI incelemesinde atriyal EMD parametreleri (PA lateral, PA septum) KAS grubunda kontrol grubuna kıyasla anlamlı derecede daha uzundu. (77,88 ±5,13 vs 65,53 ±9,11 ms; P <0,0001; 63,77 ±3,95 vs 54,56 ± 7,13 ms; P <0,0001 sırasıyla) Hem interatriyal hem de intra-atriyal EMD sürelerinin CAS grubunda kontrol grubuna göre daha uzun olduğu bulundu (31,72 ± 7,39 vs 22,13 ± 8,67 ms; P <0,0001; 17,61 ± 7,76 vs 11,16 ± 7,76 vs 11,16 ± 7,04 ms; p <0,001, sırasıyla). Korelasyon analizinde, interatriyal ve interatriyal EMD ile Pmax ve PD arasında pozitif bir ilişki bulundu. (p<0,001, her ikisi de) Sonuç: KAS hastalarında hem intraatriyal hem de interatriyal elektromekanik iletim sürelerinin daha uzun olduğunu bulduk. Bu, KAS hastalarının takiplerinde AF riski altında olduğunu düşündürmektedir.

Keywords

• Karotid arter stenozu
• atriyal fibrilasyon
• atriyal iletim süresi

Prolonged atrial electromechanical delay and P-wave parameters in asymptomatic carotid artery stenosis: novel insights from a non-invasive evaluation

Abstract

Aims: Stroke is one of the top three causes of death in developed societies. Ischemic strokes are linked to carotid artery stenosis (CAS). Atrial fibrillation (AF) is a commonly encountered clinical arrhythmia. It has been shown that the prolongation of intra- and interatrial conduction times, known as atrial electromechanical delay (EMD), is associated with a higher risk of AF. We aimed to determine the correlation of atrial conduction abnormalities between surface electrocardiographic and TDI measurements in the CAS patient group. Methods: The study included 76 patients diagnosed with extracranial internal carotid artery (ICA) stenosis. Asymptomatic severe CAS was defined as patients with 70-99% stenosis detected by carotid digital subtraction angiography (DSA). The longest P-wave and the longest atrial conduction time ACT were considered as the maximal P-wave duration. The difference between the longest P-wave (Pmax) and the shortest P-wave (Pmin) was accepted as PD. (PD=Pmax-Pmin). Atrial EMD was defined as the time interval from the onset of atrial electrical activity to the beginning of mechanical atrial contraction. Results: The CAS group had significantly longer Pmax and PD values compared to the control group (Pmax 104.72±6.03 and 93.06±7.26 ms, p<0.001; PD 48.55±6.72 and 38.50±8.12 ms, p<0.001). In the TDI examination, the atrial EMD parameters (PA lateral, PA septum) were significantly longer in the CAS group compared to the control group. (77.88±5.13 vs 65.53±9.11 ms; p<0.0001; 63.77±3.95 vs 54.56±7.13 ms; p<0.001 respectively) Both interatrial and intra-atrial EMD times were found to be longer in the CAS group compared to the control group (31.72±7.39 vs 22.13±8.67 ms; p<0.001; 17.61±7.76 vs 11.16±7.76 vs 11.16±7.04 ms; p<0.001, respectively). In the correlation analysis, a positive relationship was found between interatrial and interatrial EMD and Pmax and PD (p<0.001, both). Conclusion: We found that both intra-atrial and inter-atrial electromechanical conduction times were longer in CAS patients. This suggests that CAS patients are at risk for AF in their follow-up.

Keywords

• Carotid artery stenosis
• atrial fibrillation
• atrial conduction time

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