IS FRAGMENTED QRS ASSOCIATED WİTH THE SEVERITY OF CAROTID ARTERY DISEASE?

Abstract

Objective: This study investigated the association between fragmented QRS and the severity of carotid artery disease.

Materials and Methods: 168 patients who underwent carotid angiography due to transient ischemic attack or ischemic stroke between March 2009 and July 2017 were enrolled in the study. Patients enrolled in the study were divided into two groups according to severity of carotid artery disease on carotid angiography. Group One consisted of patients with a carotid stenosis of <50% (n:82) and group 2 consisted of patients with a carotid stenosis of ≥50% (n:86). Two groups were compared in terms of existence of fragmented QRS on electrocardiogram prior to carotid endarterectomy by using hospital records.

Results: The study group consisted of 168 patients. Group One showed more male predominance and this indicated a significant difference in terms of gender between two groups (p=0.026). Existence of chronic obstructive pulmonary disease was more common in group 2 and this indicated a statistically significant difference (p=0.001). 12-lead ECG of patients in group 2 tended to demonstrate fQRS much frequently compared to patients in group 1 (p=0.002).

Conclusion: fQRS seems to be associated with the severity of CAD and assessment of fQRS can be a predictive factor to determine high risk patients for concealed coronary artery disease in patients with severe carotid artery disease and without a history of coronary artery disease.

Keywords

• Electrocardiography,Coronary artery disease,Carotid artery disease

Fragmente Qrs Karotis Arter Hastalığının Ciddiyeti ile İlişkili Midir?

Abstract

Amaç: Bu çalışmada fragmente QRS ile karotis arter hastalığının ciddiyeti arasındaki ilişki araştırılmıştır.

Gereç ve Yöntemler: Mart 2009 ve Temmuz 2017 tarihleri arasında geçici iskemik atak veya iskemik inme nedeni karotis anjiyografi uygulanan 168 hasta çalışmaya dahil edldi. Çalışmaya dahil edilen hastalar karotis anjiyografideki karotis arter hastalığının ciddiyetine göre 2 sınıfa ayrıldı. İlk grupta karotis darlığı %50’nin altında olan hastalar var iken (n:82) ikinci grupta karotis darlığı ≥%50 olan hastalardan oluşmaktaydı (n:86). İki grup karotis endarterektomi ameliyatı öncesi elektrokardiyogramları taranarak fragmente QRS varlığı açısından karşılaştırıldı.

Bulgular: Çalışma populasyonu toplam 168 hastadan oluşmaktaydı. Birinci grupta erkek cinsiyet hakimdi ve bu istatistiksel olarak anlamlı idi (p=0.026). Kronik obstruktif akciğer hatslığı ise ikinci grupta daha fazla idi ve bu istatistiksel olarak anlamlı idi (p=0.001). İkinci gruptaki hastaların 12 derivasyonlu elektrokardiyogramlarında fragmente QRS varlığı birinci gruba kıyasla istatistiksel olarak daha fazla idi (p=0.002).

Sonuç: Fragmente QRS varlığı karotis arter hastalığının ciddiyeti ile ilişkili görünmektedir. Fragmente QRS değerlendirilmesi ciddi karotis arter hastalığına sahip olup tanısı konmamış latent koroner arter hastalığı olan hastaların saptanmasını tahmin ettirici bir faktör olarak kullanılabilir. 

Keywords

• Elektrokardiyografi,Koroner Arter Hastalığı,Karotis Arter Hastalığı

References

1. 1- Bhatt DL, Eagle KA, Ohman EM, Hirsch AT, Goto S, Mahoney EM, et al. Comparative determinants of 4-year cardiovascular event rates in stable outpatients at risk of or with atherothrombosis. JAMA 2010;304:1350e1357.
2. 2- Basaran Y, Tigen K, Karaahmet T, Isiklar I, Cevik C, Gurel E, et al. Fragmented QRS complexes are associated with cardiac fibrosis and significant intraventricular systolic dyssynchrony in nonischemic dilated cardiomyopathy patients with a narrow QRS interval. Echocardiography 2011;28(1):62–68.
3. 3- Das MK, Saha C, El Masry H, Peng J, Dandamudi G, Mahenthiran J, et al. Fragmented QRS on a 12-lead ECG: A predictor of mortality and cardiac events in patients with coronary artery disease. Heart Rhythm 2007;4:1385–1392.
4. 4- Chatterjee S, Changawala N. Fragmented QRS complex: A novel marker of cardiovascular disease. Clin Cardiol 2010;33:68–71
5. 5- Das MK, Maskoun W, Shen C, Michael MA, Suradi H, Desai M, et al. Fragmented QRS on twelve-lead electrocardiogram predicts arrhythmic events in patients with ischemic and nonischemic cardiomyopathy. Heart Rhythm 2010;7:74–80.
6. 6- Canpolat U, Kabakci G, Aytemir K, Dural M, Sahiner L, Yorgun H, et al. Fragmented QRS complex predicts the arrhythmic events in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia. J Cardiovasc Electrophysiol 2013;24:1260–1266.
7. 7- Wang J, Tang M, Mao KX, Chu JM, Hua W, Jia YH, et al. Idiopathic ventricular fibrillation with fragmented QRS complex and J wave in resting electrocardiogram. J Geriatr Cardiol 2012;9:143– 147.
8. 8- Godet G, Riou B, Bertrand M, Fle´ron MH, Goarin JP, Montalescot G, et al. Does preoperative coronary angioplasty improve postoperative cardiac outcome? Anesthesiology 2005;102:739e46.

9. 9- Sprung J, Abdelmalak B, Gottlieb A, Mayhew C, Hammel J, Levy PJ, et al. Analysis of risk factors for myocardial infarction and cardiac mortality after major vascular surgery. Anesthesiology 2000;93:129e40.
10. 10- Brilakis ES, Orford JL, Fasseas P, Wilson SH, Melby S, Lennon RJ, et al. Outcome of patients undergoing balloon angioplasty in the two months prior to noncardiac surgery. Am J Cardiol 2005; 96:512e4
11. 11- Rihal CS, Eagle KA, Mickel MC, Foster ED, Sopko G, Gersh BJ. Surgical therapy for coronary artery disease among patients with combined coronary artery and peripheral vascular disease. Circulation 1995;91:46e53.
12. 12- Jung JL, Jae HL, Jin WJ, Jun YC. Fragmented QRS and abnormal creatine kinase-MB are predictors of coronary artery disease in patients with angina and normal electrocardiographs. Korean J Intern Med 2017;32:469-477
13. 13- Korkmaz A, Yildiz A, Demir M, Ozyazgan B, Sahan E, Acar B, et al. The relationship between fragmented QRS and functional significance of coronary lesions. J Electrocardiol. 2017 May - Jun;50(3):282-286.