Effect of Coronary Collateral Circulation on Preoperative and Postoperative QT Dispersion in Patients Undergoing Coronary Artery Bypass Grafting.

Abstract

Objective: This study is designed to investigate the effects of coronary collateral circulation on preoperative and postoperative QT dispersion in patients undergoing CABG operation. Method: Fifty-two patients undergoing isolated coronary artery bypass were enrolled in this study. These patients were classified according to the presence or absence of collateral vessels into 3 groups; presence of collateral vessels from right coronary system to left coronary system (Group 1, n=13), from left coronary system to right coronary (Group 2, n=15), and absence of collaterals (control group, n=24). In all patients, 12-lead electrocardiography was recorded to calculate QT dispersion preoperatively and on the first, 5th, and 30th postoperative day. Results: Comparisons of the groups' preoperative characteristics identified a significantly higher prevalence of hypertension in Group 1 and Group 2 than that in control group. Mean preoperative QTd was significantly prolonged in Group 2 than that in control group and in Group 1. There was a significant reduction in QTd from before surgery to all postoperative measurements in control group and in Group 1. However, mean QTd in Group 2 did not showed a significant decrease after surgery in Group 2. Conclusion: The study showed that coronary artery bypass grafting may reduce QTd. However, presence of collateral circulation in patients undergoing coronary artery surgery did not affect preoperative and postoperative QTd. Key Word: Collateral circulation, Coronary disease, Coronary artery bypass, QT dispersion.

Keywords

• -

Koroner Arter Cerrahisi Yapılan Hastalarda Koroner Kollateral Dolaşımın QT Dispersiyonu Üzerine Etkisi

Öz

Amaç: Bu çalışmanın amacı koroner arter bypass greftleme yapılan hastalarda koroner kollateral dolaşım yapısının ameliyat öncesi ve sonrası QT dispersiyonu (QTd) üzerine etkisini araştırmaktır. Gereç ve Yöntem: Koroner arter cerrahisi yapılan 52 hasta çalışmaya alındı. Hastalar, koroner kollateral damarların varlığına göre sol koroner sistemden sağ koroner sisteme (Grup 1, n=13), sağ koroner sistemden sol koroner sisteme (Grup 2, n=15) ve kollateral dolaşım yapısı olmayanlar (kontrol grubu, n=24) olmak üzere 3 gruba ayrıldı. Tüm hastalarda ameliyat öncesi ve ameliyat sonrası 1., 5. ve 30. günlerde, 12 derivasyonlu elektrokardiyografi çekilerek QTd hesaplandı. Bulgular: Preoperatif hasta özellikleri kıyaslandığında koroner kollateral dolaşımı olan Grup 1 ve Grup 2 hastalarda hipertansiyon sıklığı kontrol grubuna göre daha fazla bulundu. Grup 2' de ameliyat öncesi ortalama QTd, kontrol grubu ve Grup 1' e göre istatistiksel anlamlı biçimde uzun bulundu. Ameliyat öncesi değerlerle kıyaslandığında, kontrol grubu ve Grup 1'de ameliyat sonrası QTd değerlerinde belirgin kısalma tespit edildi. Bununla birlikte, Grup 2' de ameliyat sonrası ölçümlerin hiçbirinde QTd' de anlamlı bir değişiklik bulunmadı. Sonuç: Çalışma, koroner arter cerrahisi sonrası QTd' de azalma olabileceğini göstermiştir. Bununla birlikte, cerrahi revaskülarizasyon yapılan hastalarda koroner kollateral dolaşım varlığının ameliyat öncesi ve sonrası QTd üzerine etkisi yoktur. Anahtar kelimeler: Koroner dolaşım, Koroner hastalık, Koroner arter bypass, QT dispersiyonu.

Anahtar Kelimeler

• Koroner dolaşım, Koroner hastalık, Koroner arter bypass, QT dispersiyonu

Kaynakça

1. Sasayama S, Fujita M. Recent insights into coronary collateral circulation. Circulation 1992;85:1197-204.
2. Aytan Y, Koşar F. Kollateral dolaşım. MN Kardiyoloji 2000;7:64-70
3. James TN. The delivery and distribution of coronary collateral circulation. Chest 1970;58:183-203.
4. Levin DC. Pathways and functional significance of the coronary collateral circulation. Circulation 1974;50:831-7.
5. Merri M, Benhorin J, Alberti M, Locati E, Moss AJ. Electrocardiographic quantitation of ventricular repolarization. Circulation 1989;80:1301-8.
6. Morgan JM, Cunningham D, Rowland E. Dispersion of monophasic action potential duration: demonstrable in humans after premature ventricular extrastimulation but not in steady state. J Am Coll Cardiol 1992;19:1244-53.
7. Zareba W, Moss AJ, le Cessie S. Dispersion of ventricular repolarization and arrhythmic cardiac death in coronary artery disease. Am J Cardiol 1994;74:550-3.
8. Teragawa H, Hirao H, Muraoka Y, Yamagata T, Matsuura H, Kajiyama G. Relation between QT dispersion and adenosine triphosphate stress thallium-201 single-photon emission computed tomographic imaging for detecting myocardial ischemia and scar. Am J Cardiol 1999;83:1152-6.

9. Stierle U, Giannitsis E, Sheikhzadeh A, Kruger D, Schmucker G, Mitusch R, Potratz J. Relation between QT dispersion and the extent of myocardial ischemia in patients with three-vessel coronary artery disease. Am J Cardiol 1998;81:564-8.
10. Cavusoglu Y, Gorenek B, Timuralp B, Unalir A, Ata N, Melek M. Comparison of QT dispersion between primary coronary angioplasty and thrombolytic therapy for acute myocardial infarction. Isr Med Assoc J 2001;3:333-7.
11. Wozniak-Skowerska I, Trusz-Gluza M, Skowerski M, Rybicka-Musialik A, Krauze J, Jaklik A, Myszor J, Cisowski M, Bochenek A. Influence of coronary artery bypass grafting on QT dispersion. Med Sci Monit 2004;10:128-31.
12. Kosar F, Nisanoglu V, Aksoy Y, Colak C, Erdil N, Battaloglu B. Effects of coronary revascularization and concomitant aneurysmectomy on QT interval duration and dispersion. J Electrocardiol 2006;39:194-8.
13. Gulcan O, Sezgin AT, Demircan S, Atalay H, Turkoz R. Effect of coronary artery bypass grafting and aneurysmectomy on QT dispersion in moderate or severe left ventricular dysfunction. Am Heart J 2005;149:917-20.
14. Papadopoulos CE, Zaglavara T, Karvounis HI, Haaverstad R, Parharidis GE, Louridas GE, Kenny A. QT dispersion is determined by the relative extent of normal, hibernating, and scarred myocardium in patients with chronic ischemic cardiomyopathy. A dobutamine stress echocardiography study before and after surgical revascularization. J Electrocardiol 2006;39:103-9.
15. Rentrop KP, Cohen M, Blanke H, Phillips RA. Changes in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects. J Am Coll Cardiol 1985;5:587-92.
16. Garson A Jr. How to measure the QT interval-what is normal? Am J Cardiol 1993;72:14B-16B.
17. Huikuri HV. QT dispersion-what does it mean? Cardiovasc Drugs Ther. 2001 Jul;15(4):299-300
18. Day CP, McComb JM, Campbell RW. QT dispersion: an indication of arrhythmia risk in patients with long QT intervals. Br Heart J 1990;63:342-4
19. Giedrimiene D, Giri S, Giedrimas A, Kiernan F, Kluger J. Effects of ischemia on repolarization in patients with single and multivessel coronary disease. Pacing Clin Electrophysiol 2003;26:390-3.
20. Lyras TG, Papapanagiotou VA, Foukarakis MG, Panou FK, Skampas ND, Lakoumentas JA, Priftis CV, Zacharoulis AA. Evaluation of serial QT dispersion in patients with first non-Q-wave myocardial infarction: relation to the severity of underlying coronary artery disease. Clin Cardiol 2003;26:189-95.
21. Paventi S, Bevilacqua U, Parafati MA, Di Luzio E, Rossi F, Pelliccioni PR. QT dispersion and early arrhythmic risk during acute myocardial infarction.Angiology 1999;50:209-15.
22. Moreno FL, Villanueva T, Karagounis LA, Anderson JL. Reduction in QT interval dispersion by successful thrombolytic therapy in acute myocardial infarction. TEAM- 2 Study Investigators. Circulation 1994;90:94-100
23. Mirvis DM. Spatial variation of QT intervals in normal persons and patients with acute myocardial infarction. J Am Coll Cardiol 1985;5:625-31.
24. Yunus A, Gillis AM, Traboulsi M, Duff HJ, Wyse DG, Knudtson ML, Mitchell LB. Effect of coronary angioplasty on precordial QT dispersion. Am J Cardiol 1997;79:1339-42.
25. Sporton SC, Taggart P, Sutton PM, Walker JM, Hardman SM. Acute ischaemia: a dynamic influence on QT dispersion. Lancet 1997;349:306-9.
26. van de Loo A, Arendts W, Hohnloser SH. Variability of QT dispersion measurements in the surface electrocardiogram in patients with acute myocardial infarction and in normal subjects. Am J Cardiol 1994;74:1113-8.
27. Schwartz H, Leiboff RH, Bren GB, Wasserman AG, Katz RJ, Varghese PJ, Sokil AB, Ross AM. Temporal evolution of the human coronary collateral circulation after myocardial infarction. J Am Coll Cardiol 1984;4:1088-93.
28. Blanke H, Cohen M, Karsch KR, Fagerstrom R, Rentrop KP. Prevalence and significance of residual flow to the infarct zone during the acute phase of myocardial infarction. J Am Coll Cardiol 1985;5:827-31.
29. Kyriakides ZS, Kremastinos DT, Michelakakis NA, Matsakas EP, Demovelis T, Toutouzas PK. Coronary collateral circulation in coronary artery disease and systemic hypertension. Am J Cardiol 1991;67:687-90.