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QRS Fragmentation is Associated with Functional Mitral Regurgitation and Papillary Muscle Dyssynchrony in Patients with Non-ischemic Dilated Cardiomyopathy and Sinus Rhythm

Yıl 2010, Cilt: 13 Sayı: 1, 5 - 10, 01.01.2009

Kursat Tigen Tansu Karaahmet Emre Gurel Selcuk Pala Cihan Dundar Mustafa Akcakoyun Cihan Cevik Ozcan Basaran Yelda Basaran

Öz

Aim: We investigated the impact of fragmented QRS (fQRS) complexes on ECG in predicting papillary muscle dyssynchrony and functional mitral regurgitation in patients with non-ischemic dilated cardiomyopathy with narrow QRS and sinus rhythm. Methods: Thirty-one non-ischemic dilated cardiomyopathy patients with fQRS and 16 patients without fQRS were evaluated for intraventricular and papillary muscle dyssynchrony. All patients were in sinus rhythm and having narrow QRS intervals. Maximal Ts (duration between the beginning of the QRS complex and myocardial peak systolic velocity), difference between basal septal and lateral myocardial segments (ASE Sep-Lat Sys) and anterolateral and posteromedial papillary muscles (ASE Inter PAP Sys) were calculated to assess synchronicity. Results: The patients with fQRS had significantly higher mitral regurgitant volume (p=0.043), shorter E wave deceleration (p=0.01) and isovolumetric relaxation time (p=0.044), lower basal septal (p=0.033) and lower basal lateral (p=0.007) TDI peak systolic velocities and higher ASE Sep-Lat Sys (p=0.041) and ASE Inter PAP Sys (p=0.033) values than patients without fQRS complexes. Conclusion: fQRS was associated with intraventricular and papillary muscle dysssynchrony and more severe functional mitral regurgitation in patients with non-ischemic dilated cardiomyopathy and sinus rhythm. The presence of fQRS complexes may be useful in selecting patients for cardiac resynchronization therapy.

Anahtar Kelimeler

Mitral stenosis mitral balloon valvuloplasty left ventricular function tissue Doppler Imaging

Kaynakça

  • ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Associ- ation Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Mana- gement of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 ;112:e154-235.
  • Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A Palensky J, Wittes J. The effect of spironolactone on mor- bidity and mortality in patients with severe heart failure. N Engl J Med 1999;341:709–17.
  • Zannad F, Briancon S, Juilliere Y, Mertes PM, Villemot JP, Alla F, Virion JM. Incidence, clinical and etiologic features, and outcomes of advanced chronic heart failure: the EPICAL study. J Am Coll Cardiol 1999;33:734–42.
  • Blondheim DS, Jacobs LE, Kotler MN, Costacurta GA, Parry WR. Dilated cardiomyopathy with mitral regurgitation: decreased survival despite a low frequency of left ventricular thrombus. Am Heart J 1991;122:763–71.
  • Junker A, Thayssen P, Nielsen B, Andersen PE. The he- modynamic and prognostic significance of echo-Doppler- proven mitral regurgitation in patients with dilated cardiom- yopathy. Cardiology 1993;83:14–20.
  • Kaul S, Spotnitz WD, Glasheen WP, Touchstone DA. Mec- hanism of ischemic mitral regurgitation: an experimental eva- luation. Circulation 1992;84:2167-80.
  • D'Cruz IA, Shroff SG, Janicki JS, Jain A, Reddy HK, Lakier JB. Differences in the shape of the normal, cardiomyopathic and volume overloaded human left ventricle. J Am Soc Echo- cardiogr 1989;2:358-67.
  • Tibayan FA, Rodriguez F, Zasio MK, Bailey L, Liang D, Da- ughters GT, Langer F, Ingels NB Jr, Miller DC. Geometric dis- tortions of the mitral valvular-ventricular complex in chronic ischemic mitral regurgitation. Circulation 2003;108:116-21.
  • Breidhart OA, Sinha AM, Schwammenthal E, Bidaoui N, Markus KU, Franke A, Stellbrink C. Acute effects of cardiac resynchronization therapy on functional mitral regurgitation in advanced systolic heart failure. J Am Coll Cardiol 2003;41:765-70.
  • Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, Tavazzi L; Cardiac Resynchronization- Heart Failure (CARE-HF) Study Investigators.: the effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005;352:1539-49.
  • Kanzaki H, Bazaz R, Schwartzman D, Dohi K, Sade LF, Gorcsan J. A mechanism for immediate reduction in mitral regurgitation after cardiac resynchronization therapy: in- sights from mechanical activation strain mapping. J Am Coll Cardiol 2004;44:1619-25.
  • Soyama A, Kono T, Mishima T, Morita H, Ito T, Suwa M, Kitaura Y. Intraventricular dyssynchrony may play a role in the development of mitral regurgitation in dilated cardiomyo- pathy. J Card Fail 2005;11:631-7.
  • Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, Carson P, DiCarlo L, DeMets D, White BG, DeV- ries DW, Feldman AM. Comparison of medical therapy, pa- cing and defibrillation in heart failure (COMPANION) investi- gators: cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004;350:2140-50.
  • Linde C, Leclercq C, Rex S, Garrigue S, Lavergne T, Ca- zeau S, McKenna W, Fitzgerald M, Deharo JC, Alonso C, Wal- ker S, Braunschweig F, Bailleul C, Daubert JC. Long-term be- nefits of biventricular pacing in congestive heart failure: re- sults from the multisite stimulation in cardiomyopathy (MUS- TIC) study. J Am Coll Cardiol 2002;40:111-8.
  • Karvounis HI, Dalamaga EG, Papadopoulos CE, Karamit- sos TD, Vassilikos V, Paraskevaidis S, Styliadis IH, Parharidis GE, Louridas GE. Improved Papillary Muscle Function Atte- nuates Functional Mitral Regurgitation in Patients with Dilated Cardiomyopathy After Cardiac Resynchronization Therapy. J Am Soc Echocardiogr 2006;19:1150-1157.
  • Ypenburg C, Lancellotti P, Tops LF, Bleeker GB, Holman ER, Piérard LA, Schalij MJ, Bax JJ. Acute Effects of Initiation and Withdrawal of Cardiac Resynchronization Therapy on Papillary Muscle Dyssynchrony and Mitral Regurgitation. J Am Coll Cardiol 2007;50:2071–7
  • Yu CM, Lin H, Zhang Q, Sanderson JE. High prevalence of left ventricular systolic and diastolic asynchrony in patients with congestive heart failure and normal QRS duration. Heart 2003;89:54–60.
  • Bleeker G, Schalij M, Molhoek S, Holman E, Verwey H, Steendijk P, van der Wall EE, Bax JJ. Frequency of Left Ven- tricular Dyssynchrony in Patients With Heart Failure and a Narrow QRS Complex. Am J Cardiol 2005;95:140–142.
  • Auricchio A, Yu CM. Beyond the measurement of QRS complex toward mechanical dyssynchrony: cardiac resyn- chronisation therapy in heart failure patients with a normal QRS duration. Heart 2004;90:479–481.
  • Ghio S, Constantin C, Klersy C, Serio A, Fontana A, Cam- pana C, Tavazzi L. Interventricular and intraventricular dys- synchrony are common in heart failure patients, regardless of QRS duration. Eur Heart J. 2004;25:571-8.
  • Dohi K, Suffoletto M, Murali S, Bazaz R, Gorcsan J. Bene- fit of cardiac resynchronization therapy to a patient with a narrow QRS complex and ventricular dyssynchrony identified by tissue synchronization imaging. Eur J Echocardiogr. 2005;6:455-60
  • Das M, Khan B, Jacob S, Kumar A, Mahenthiran J. Signi- ficance of a Fragmented QRS Complex Versus a Q Wave in Patients With Coronary Artery Disease. Circulation. 2006;113:2495-2501.
  • Das M, Saha C, El Masry H, Peng J, Dandamudi G, Ma- henthiran J, McHenry P, Zipes DP. Fragmented QRS on a 12- lead ECG: A predictor of mortality and cardiac events in pa- tients with coronary artery disease. Heart Rhythm 2007;4:1385–1392.
  • Pietrasik G, Goldenberg I, Zdzienicka J, Moss A, Zareba W. Prognostic Significance of Fragmented QRS Complex for Predicting the Risk of Recurrent Cardiac Events in Patients With Q-Wave Myocardial Infarction. Am J Cardiol 2007;100:583–586.
  • El-Sherif N. The rsR’ pattern in left surface leads in ven- tricular aneurysm. Br Heart J 1970;32:440-8.
  • Reddy CV, Cheriparambill K, Saul B, Makan M, Kassotis J, Kumar A, Das MK. Fragmented left sided QRS in absence of bundle branch block: sign of left ventricular aneurysm. Ann Noninvasive Electrocardiol 2006;11:132-8.
  • Sahn DJ, DeMaria A, Kisslo J, Weyman A. Recommenda- tions regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Cir- culation 1978;58:1072–83.
  • Bargiggia GS, Bertucci C, Recusani F, Raisaro A, de Ser- vi S, Valdes-Cruz LM, Sahn DJ, Tronconi L. A new method for estimating left ventricular dP/dt by continuous wave Doppler-echocardiography: validation studies at cardiac cat- heterization. Circulation 1989;80:1287-92.
  • Yu CM, Wang Q, Lau CP, Tse HF, Leung SK, Lee KL, Tsang V, Ayers G. Reversible impairment of left and right ven- tricular systolic and diastolic function during short-lasting at- rial fibrillation in patients with an implantable atrial defibrilla- tor: a tissue Doppler imaging study. Pacing Clin Electrophysi- ol 2001;24:979–88.
  • Yu CM, Chau E, Sanderson JE, Fan K, Tang MO, Fung WH, Lin H, Kong SL, Lam YM, Hill MR, Lau CP. Tissue Dopp- ler echocardiographic evidence of reverse remodeling and improved synchronicity by simultaneously delaying regional contraction after biventricular pacing therapy in heart failure. Circulation 2002;105:438–45.
  • Bleeker GB, Schalij MJ, Molhoek SG, Verwey HF, Holman ER, Boersma E, Steendijk P, Van Der Wall EE, Bax JJ. Relati- onship between QRS duration and left ventricular dyssyn- chrony in patients with end-stage heart failure. J Cardiovasc Electrophysiol 2004;15:544 –549.
  • Bax JJ, Marwick TH, Molhoek SG, Bleeker GB, van Erven L, Boersma E, Steendijk P, van der Wall EE, Schalij MJ. Left ventricular dyssynchrony predicts benefit of cardiac resyn- chronization therapy in patients with end-stage heart failure before pacemaker implantation. Am J Cardiol. 2003 15;92(10):1238-40.
  • Enriquez-Sarano M, Miller FA, Hayes SN, Bailey KR, Se- ward JB. Effective mitral regurgitant orifice area: clinical use and pitfalls of the proximal isovelocity surface area method. J Am Coll Cardiol 1995;25:703-9.
  • Grigioni F, Enriquez-Sarano M, Zehr KJ, Bailey KR, Tajik AJ. Ischemic mitral regurgitation: long term outcome and prognostic implications with quantitative Doppler assess- ment. Circulation 2001;103:1759-64.
  • Hausmann H, Siniawski H, Hetzer R. Mitral valve recons- truction and replacement for ischemic mitral insufficiency: seven years follow up. J Heart Valve Dis 1999;8:536-42.
  • Tibayan FA, Rodriguez F, Langer F, Zasio MK, Bailey L, Liang D, Daughters GT, Ingels NB Jr, Miller DC. Annular re- modeling in chronic ischemic mitral regurgitation: ring selec- tion implications. Ann Thorac Surg 2003;76:1549–54.
  • Rankin JS, Feneley MP, Hickey MS, Muhlbaier LH, Wech- sler AS, Floyd RD, Reves JG, Skelton TN, Califf RM, Lowe JE. A clinical comparison of mitral valve repair versus valve rep- lacement in ischemic mitral regurgitation. J Thorac Cardio- vasc Surg 1988;95:165–177.
  • Brandt RR, Reiner C, Arnold R, Sperzel J, Pitschner HF, Hamm CW. Contractile response and mitral regurgitation af- ter temporary interruption of long-term cardiac resynchroni- zation therapy. Eur Heart J 2006;27:187-92.
  • Achilli A, Sassara M, Ficili S, Pontillo D, Achilli P, Alessi C, De Spirito S, Guerra R, Patruno N, Serra F. Long-term effec- tiveness of cardiac resynchronization therapy in patients with refractory heart failure and ‘‘narrow’’ QRS. J Am Coll Cardiol 2003;42:2117–24.
  • Flowers NC, Horan LG, Thomas JR, Tolleson WJ. The anatomic basis for high-frequency components in the elec- trocardiogram. Circulation 1969;39:531–539.
  • Gardner PI, Ursell PC, Fenoglio JJ Jr, Wit AL. Electroph- ysiologic and anatomic basis for fractionated electrograms recorded from healed myocardial infarcts. Circulation 1985;72:596–611.
  • Bolling SF, Pagani FD, Deeb GM, Bach DS. Intermediate- term outcome of mitral reconstruction in cardiomyopathy. J Thorac Cardiovasc Surg 1998;115:381–6.

Sinüs Ritmindeki Non-iskemik Dilate Kardiyomiyopatili Hastalarda EKG'de Fragmante QRS Varl›¤› Papiller Kas Dissenkronisi ve Fonksiyonel Mitral Yetersizli¤i ile ‹liflkilidir

Yıl 2010, Cilt: 13 Sayı: 1, 5 - 10, 01.01.2009

Kursat Tigen Tansu Karaahmet Emre Gurel Selcuk Pala Cihan Dundar Mustafa Akcakoyun Cihan Cevik Ozcan Basaran Yelda Basaran

Öz

Amaç: Çal›flmam›zda dar qrs'li non-iskemik dilate kardiyomiyopatili hastalarda ekg'de fragmante qrs varl›¤›n›n fonksiyonel mitral yetersizli¤i ve papiller kas asenkroni ile iliflkisi incelendi. Metodoloji: Sol ventrikül ejeksiyon fraksiyonu < %40 olan sinüs ritmindeki dar (

Anahtar Kelimeler

Kardiyomiyopati dissenkroni fragmante QRS

Kaynakça

  • ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Associ- ation Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Mana- gement of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 ;112:e154-235.
  • Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A Palensky J, Wittes J. The effect of spironolactone on mor- bidity and mortality in patients with severe heart failure. N Engl J Med 1999;341:709–17.
  • Zannad F, Briancon S, Juilliere Y, Mertes PM, Villemot JP, Alla F, Virion JM. Incidence, clinical and etiologic features, and outcomes of advanced chronic heart failure: the EPICAL study. J Am Coll Cardiol 1999;33:734–42.
  • Blondheim DS, Jacobs LE, Kotler MN, Costacurta GA, Parry WR. Dilated cardiomyopathy with mitral regurgitation: decreased survival despite a low frequency of left ventricular thrombus. Am Heart J 1991;122:763–71.
  • Junker A, Thayssen P, Nielsen B, Andersen PE. The he- modynamic and prognostic significance of echo-Doppler- proven mitral regurgitation in patients with dilated cardiom- yopathy. Cardiology 1993;83:14–20.
  • Kaul S, Spotnitz WD, Glasheen WP, Touchstone DA. Mec- hanism of ischemic mitral regurgitation: an experimental eva- luation. Circulation 1992;84:2167-80.
  • D'Cruz IA, Shroff SG, Janicki JS, Jain A, Reddy HK, Lakier JB. Differences in the shape of the normal, cardiomyopathic and volume overloaded human left ventricle. J Am Soc Echo- cardiogr 1989;2:358-67.
  • Tibayan FA, Rodriguez F, Zasio MK, Bailey L, Liang D, Da- ughters GT, Langer F, Ingels NB Jr, Miller DC. Geometric dis- tortions of the mitral valvular-ventricular complex in chronic ischemic mitral regurgitation. Circulation 2003;108:116-21.
  • Breidhart OA, Sinha AM, Schwammenthal E, Bidaoui N, Markus KU, Franke A, Stellbrink C. Acute effects of cardiac resynchronization therapy on functional mitral regurgitation in advanced systolic heart failure. J Am Coll Cardiol 2003;41:765-70.
  • Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, Tavazzi L; Cardiac Resynchronization- Heart Failure (CARE-HF) Study Investigators.: the effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005;352:1539-49.
  • Kanzaki H, Bazaz R, Schwartzman D, Dohi K, Sade LF, Gorcsan J. A mechanism for immediate reduction in mitral regurgitation after cardiac resynchronization therapy: in- sights from mechanical activation strain mapping. J Am Coll Cardiol 2004;44:1619-25.
  • Soyama A, Kono T, Mishima T, Morita H, Ito T, Suwa M, Kitaura Y. Intraventricular dyssynchrony may play a role in the development of mitral regurgitation in dilated cardiomyo- pathy. J Card Fail 2005;11:631-7.
  • Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, Carson P, DiCarlo L, DeMets D, White BG, DeV- ries DW, Feldman AM. Comparison of medical therapy, pa- cing and defibrillation in heart failure (COMPANION) investi- gators: cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004;350:2140-50.
  • Linde C, Leclercq C, Rex S, Garrigue S, Lavergne T, Ca- zeau S, McKenna W, Fitzgerald M, Deharo JC, Alonso C, Wal- ker S, Braunschweig F, Bailleul C, Daubert JC. Long-term be- nefits of biventricular pacing in congestive heart failure: re- sults from the multisite stimulation in cardiomyopathy (MUS- TIC) study. J Am Coll Cardiol 2002;40:111-8.
  • Karvounis HI, Dalamaga EG, Papadopoulos CE, Karamit- sos TD, Vassilikos V, Paraskevaidis S, Styliadis IH, Parharidis GE, Louridas GE. Improved Papillary Muscle Function Atte- nuates Functional Mitral Regurgitation in Patients with Dilated Cardiomyopathy After Cardiac Resynchronization Therapy. J Am Soc Echocardiogr 2006;19:1150-1157.
  • Ypenburg C, Lancellotti P, Tops LF, Bleeker GB, Holman ER, Piérard LA, Schalij MJ, Bax JJ. Acute Effects of Initiation and Withdrawal of Cardiac Resynchronization Therapy on Papillary Muscle Dyssynchrony and Mitral Regurgitation. J Am Coll Cardiol 2007;50:2071–7
  • Yu CM, Lin H, Zhang Q, Sanderson JE. High prevalence of left ventricular systolic and diastolic asynchrony in patients with congestive heart failure and normal QRS duration. Heart 2003;89:54–60.
  • Bleeker G, Schalij M, Molhoek S, Holman E, Verwey H, Steendijk P, van der Wall EE, Bax JJ. Frequency of Left Ven- tricular Dyssynchrony in Patients With Heart Failure and a Narrow QRS Complex. Am J Cardiol 2005;95:140–142.
  • Auricchio A, Yu CM. Beyond the measurement of QRS complex toward mechanical dyssynchrony: cardiac resyn- chronisation therapy in heart failure patients with a normal QRS duration. Heart 2004;90:479–481.
  • Ghio S, Constantin C, Klersy C, Serio A, Fontana A, Cam- pana C, Tavazzi L. Interventricular and intraventricular dys- synchrony are common in heart failure patients, regardless of QRS duration. Eur Heart J. 2004;25:571-8.
  • Dohi K, Suffoletto M, Murali S, Bazaz R, Gorcsan J. Bene- fit of cardiac resynchronization therapy to a patient with a narrow QRS complex and ventricular dyssynchrony identified by tissue synchronization imaging. Eur J Echocardiogr. 2005;6:455-60
  • Das M, Khan B, Jacob S, Kumar A, Mahenthiran J. Signi- ficance of a Fragmented QRS Complex Versus a Q Wave in Patients With Coronary Artery Disease. Circulation. 2006;113:2495-2501.
  • Das M, Saha C, El Masry H, Peng J, Dandamudi G, Ma- henthiran J, McHenry P, Zipes DP. Fragmented QRS on a 12- lead ECG: A predictor of mortality and cardiac events in pa- tients with coronary artery disease. Heart Rhythm 2007;4:1385–1392.
  • Pietrasik G, Goldenberg I, Zdzienicka J, Moss A, Zareba W. Prognostic Significance of Fragmented QRS Complex for Predicting the Risk of Recurrent Cardiac Events in Patients With Q-Wave Myocardial Infarction. Am J Cardiol 2007;100:583–586.
  • El-Sherif N. The rsR’ pattern in left surface leads in ven- tricular aneurysm. Br Heart J 1970;32:440-8.
  • Reddy CV, Cheriparambill K, Saul B, Makan M, Kassotis J, Kumar A, Das MK. Fragmented left sided QRS in absence of bundle branch block: sign of left ventricular aneurysm. Ann Noninvasive Electrocardiol 2006;11:132-8.
  • Sahn DJ, DeMaria A, Kisslo J, Weyman A. Recommenda- tions regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Cir- culation 1978;58:1072–83.
  • Bargiggia GS, Bertucci C, Recusani F, Raisaro A, de Ser- vi S, Valdes-Cruz LM, Sahn DJ, Tronconi L. A new method for estimating left ventricular dP/dt by continuous wave Doppler-echocardiography: validation studies at cardiac cat- heterization. Circulation 1989;80:1287-92.
  • Yu CM, Wang Q, Lau CP, Tse HF, Leung SK, Lee KL, Tsang V, Ayers G. Reversible impairment of left and right ven- tricular systolic and diastolic function during short-lasting at- rial fibrillation in patients with an implantable atrial defibrilla- tor: a tissue Doppler imaging study. Pacing Clin Electrophysi- ol 2001;24:979–88.
  • Yu CM, Chau E, Sanderson JE, Fan K, Tang MO, Fung WH, Lin H, Kong SL, Lam YM, Hill MR, Lau CP. Tissue Dopp- ler echocardiographic evidence of reverse remodeling and improved synchronicity by simultaneously delaying regional contraction after biventricular pacing therapy in heart failure. Circulation 2002;105:438–45.
  • Bleeker GB, Schalij MJ, Molhoek SG, Verwey HF, Holman ER, Boersma E, Steendijk P, Van Der Wall EE, Bax JJ. Relati- onship between QRS duration and left ventricular dyssyn- chrony in patients with end-stage heart failure. J Cardiovasc Electrophysiol 2004;15:544 –549.
  • Bax JJ, Marwick TH, Molhoek SG, Bleeker GB, van Erven L, Boersma E, Steendijk P, van der Wall EE, Schalij MJ. Left ventricular dyssynchrony predicts benefit of cardiac resyn- chronization therapy in patients with end-stage heart failure before pacemaker implantation. Am J Cardiol. 2003 15;92(10):1238-40.
  • Enriquez-Sarano M, Miller FA, Hayes SN, Bailey KR, Se- ward JB. Effective mitral regurgitant orifice area: clinical use and pitfalls of the proximal isovelocity surface area method. J Am Coll Cardiol 1995;25:703-9.
  • Grigioni F, Enriquez-Sarano M, Zehr KJ, Bailey KR, Tajik AJ. Ischemic mitral regurgitation: long term outcome and prognostic implications with quantitative Doppler assess- ment. Circulation 2001;103:1759-64.
  • Hausmann H, Siniawski H, Hetzer R. Mitral valve recons- truction and replacement for ischemic mitral insufficiency: seven years follow up. J Heart Valve Dis 1999;8:536-42.
  • Tibayan FA, Rodriguez F, Langer F, Zasio MK, Bailey L, Liang D, Daughters GT, Ingels NB Jr, Miller DC. Annular re- modeling in chronic ischemic mitral regurgitation: ring selec- tion implications. Ann Thorac Surg 2003;76:1549–54.
  • Rankin JS, Feneley MP, Hickey MS, Muhlbaier LH, Wech- sler AS, Floyd RD, Reves JG, Skelton TN, Califf RM, Lowe JE. A clinical comparison of mitral valve repair versus valve rep- lacement in ischemic mitral regurgitation. J Thorac Cardio- vasc Surg 1988;95:165–177.
  • Brandt RR, Reiner C, Arnold R, Sperzel J, Pitschner HF, Hamm CW. Contractile response and mitral regurgitation af- ter temporary interruption of long-term cardiac resynchroni- zation therapy. Eur Heart J 2006;27:187-92.
  • Achilli A, Sassara M, Ficili S, Pontillo D, Achilli P, Alessi C, De Spirito S, Guerra R, Patruno N, Serra F. Long-term effec- tiveness of cardiac resynchronization therapy in patients with refractory heart failure and ‘‘narrow’’ QRS. J Am Coll Cardiol 2003;42:2117–24.
  • Flowers NC, Horan LG, Thomas JR, Tolleson WJ. The anatomic basis for high-frequency components in the elec- trocardiogram. Circulation 1969;39:531–539.
  • Gardner PI, Ursell PC, Fenoglio JJ Jr, Wit AL. Electroph- ysiologic and anatomic basis for fractionated electrograms recorded from healed myocardial infarcts. Circulation 1985;72:596–611.
  • Bolling SF, Pagani FD, Deeb GM, Bach DS. Intermediate- term outcome of mitral reconstruction in cardiomyopathy. J Thorac Cardiovasc Surg 1998;115:381–6.
Toplam 42 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Makaleler
Yazarlar

Kursat Tigen Bu kişi benim

Tansu Karaahmet Bu kişi benim

Emre Gurel Bu kişi benim

Selcuk Pala Bu kişi benim

Cihan Dundar Bu kişi benim

Mustafa Akcakoyun Bu kişi benim

Cihan Cevik Bu kişi benim

Ozcan Basaran Bu kişi benim

Yelda Basaran Bu kişi benim

Yayımlanma Tarihi 1 Ocak 2009
Yayımlandığı Sayı Yıl 2010 Cilt: 13 Sayı: 1

Kaynak Göster

APA Tigen, K. ., Karaahmet, T. ., Gurel, E. ., Pala, S. ., vd. (2009). Sinüs Ritmindeki Non-iskemik Dilate Kardiyomiyopatili Hastalarda EKG’de Fragmante QRS Varl›¤› Papiller Kas Dissenkronisi ve Fonksiyonel Mitral Yetersizli¤i ile ‹liflkilidir. Koşuyolu Kalp Dergisi, 13(1), 5-10.
AMA Tigen K, Karaahmet T, Gurel E, Pala S, Dundar C, Akcakoyun M, Cevik C, Basaran O, Basaran Y. Sinüs Ritmindeki Non-iskemik Dilate Kardiyomiyopatili Hastalarda EKG’de Fragmante QRS Varl›¤› Papiller Kas Dissenkronisi ve Fonksiyonel Mitral Yetersizli¤i ile ‹liflkilidir. Koşuyolu Kalp Dergisi. Ocak 2009;13(1):5-10.
Chicago Tigen, Kursat, Tansu Karaahmet, Emre Gurel, Selcuk Pala, Cihan Dundar, Mustafa Akcakoyun, Cihan Cevik, Ozcan Basaran, ve Yelda Basaran. “Sinüs Ritmindeki Non-Iskemik Dilate Kardiyomiyopatili Hastalarda EKG’de Fragmante QRS Varl›¤› Papiller Kas Dissenkronisi Ve Fonksiyonel Mitral Yetersizli¤i Ile ‹liflkilidir”. Koşuyolu Kalp Dergisi 13, sy. 1 (Ocak 2009): 5-10.
EndNote Tigen K, Karaahmet T, Gurel E, Pala S, Dundar C, Akcakoyun M, Cevik C, Basaran O, Basaran Y (01 Ocak 2009) Sinüs Ritmindeki Non-iskemik Dilate Kardiyomiyopatili Hastalarda EKG’de Fragmante QRS Varl›¤› Papiller Kas Dissenkronisi ve Fonksiyonel Mitral Yetersizli¤i ile ‹liflkilidir. Koşuyolu Kalp Dergisi 13 1 5–10.
IEEE K. . Tigen, T. . Karaahmet, E. . Gurel, S. . Pala, C. . Dundar, M. . Akcakoyun, C. . Cevik, O. . Basaran, ve Y. . Basaran, “Sinüs Ritmindeki Non-iskemik Dilate Kardiyomiyopatili Hastalarda EKG’de Fragmante QRS Varl›¤› Papiller Kas Dissenkronisi ve Fonksiyonel Mitral Yetersizli¤i ile ‹liflkilidir”, Koşuyolu Kalp Dergisi, c. 13, sy. 1, ss. 5–10, 2009.
ISNAD Tigen, Kursat vd. “Sinüs Ritmindeki Non-Iskemik Dilate Kardiyomiyopatili Hastalarda EKG’de Fragmante QRS Varl›¤› Papiller Kas Dissenkronisi Ve Fonksiyonel Mitral Yetersizli¤i Ile ‹liflkilidir”. Koşuyolu Kalp Dergisi 13/1 (Ocak 2009), 5-10.
JAMA Tigen K, Karaahmet T, Gurel E, Pala S, Dundar C, Akcakoyun M, Cevik C, Basaran O, Basaran Y. Sinüs Ritmindeki Non-iskemik Dilate Kardiyomiyopatili Hastalarda EKG’de Fragmante QRS Varl›¤› Papiller Kas Dissenkronisi ve Fonksiyonel Mitral Yetersizli¤i ile ‹liflkilidir. Koşuyolu Kalp Dergisi. 2009;13:5–10.
MLA Tigen, Kursat vd. “Sinüs Ritmindeki Non-Iskemik Dilate Kardiyomiyopatili Hastalarda EKG’de Fragmante QRS Varl›¤› Papiller Kas Dissenkronisi Ve Fonksiyonel Mitral Yetersizli¤i Ile ‹liflkilidir”. Koşuyolu Kalp Dergisi, c. 13, sy. 1, 2009, ss. 5-10.
Vancouver Tigen K, Karaahmet T, Gurel E, Pala S, Dundar C, Akcakoyun M, Cevik C, Basaran O, Basaran Y. Sinüs Ritmindeki Non-iskemik Dilate Kardiyomiyopatili Hastalarda EKG’de Fragmante QRS Varl›¤› Papiller Kas Dissenkronisi ve Fonksiyonel Mitral Yetersizli¤i ile ‹liflkilidir. Koşuyolu Kalp Dergisi. 2009;13(1):5-10.