Increased Ventricular Activation Time in Patients with the Diagnosis of Cardiac Syndrome X

Introduction: Cardiac syndrome X (CSX) is defined as typical angina with detectable ischaemia on noninvasive stress tests without any evidence of coronary artery stenosis during coronary angiography. Impairedcoronary microcirculation, inflammation and endothelial dysfunction are accepted aetiological factors forCSX. The ventricular activation time (VAT) has been reported to be prolonged in myocardial ischaemia dueto the conduction delay in the Purkinje fibres and the myocytes. In this study, we aimed to investigate theelectrocardiographic parameters including VAT in patients with CSX.Patients and Methods: This study enrolled 120 patients (mean age, 54.7 ± 8.6 years; male, 53) diagnosedwith CSX and 130 healthy controls (mean age, 53.3 ± 8.9; male, 66) without ischaemia. All patients underwent electrocardiography and transthoracic echocardiography. VAT was defined as the interval from thebeginning of the QRS complex until the peak of the R or R’ wave.Results: There was no significant difference in terms of demographic, laboratory and echocardiographic parameters between CSX patients and controls. Comparison of electrocardiographic parameters yielded that therewas no significant difference in terms of the heart rate, P-wave duration, PR interval, QT and corrected QTintervals between the groups. However, the QRS duration (95.1 ± 13.8 vs. 90.4 ± 12.7 msec; p= 0.006) and VAT(34.8 ± 5.7 vs. 29.2 ± 5.6 msec; p< 0.001) were significantly higher in patients with CSX.Conclusion: The present study demonstrated that QRS duration and VAT were prolonged significantly inpatients with CSX. This prolongation may be due to the presence of impaired microvascular perfusion andischaemia-induced conduction delay.

Anahtar Kelime:

The effect of blood pressure variability on the prognosis of hypertensive patients

Öz:

Objective: Our study aims to compare the effects of blood pressure variability (BPV) during ambulatory blood pressure measurement (ABPM)and visit-to-visit measurements to predict future cardiovascular complications among hypertensive patients.Methods: This is a retrospective case-control study of patients with hypertension over 10 years. All adult patients with at least one recordedABPM, and at least three recorded visit measurements were included. Patients with incomplete ABPM readings, a history of a tested outcome,or the occurrence of any of the tested outcomes within the measurement period were excluded. The outcome was the development of any ofthe following: acute coronary syndrome (ACS), chronic ischemic heart disease (IHD), heart failure (HF), or stroke.Results: Of the 305 cases reviewed, 152 were included. The mean follow-up was 6.6±2.3 years. The mean age was 53.5±14.3 years. Eighty-two (53.9%) patients were male, while 70 (46.1%) were female. Risk factors included diabetes mellitus (53.9%), dyslipidemia (39.5%), obesity (16.4%), and smoking (8.6%). Comorbidities included stroke (2%), ACS (8.6%), IHD (20.4%), HF (2.6%), and renal failure (1.3%). One or more complications were seen in 22.4 % of the included patients. The variation of the daytime systolic ABP had been found to predict the future risk of developing IHD (OR=1.94; 95% CI=1.09–3.45; p=0.025). Moreover, IHD was associated with night-time systolic standard deviation (SD) in ABPM (OR=1.23;95% CI=1.00–1.51; p=0.048). On the other side, ACS was found to be associated with systolic SD in visit-to-visit measurement (OR=1.10; 95%CI=1.01–1.21; p=0.04).Conclusion: Hypertensive patients with high variability of daytime and night-time SD in ABPM are more likely to have IHD. Whereas, having high variability in systolic SD in visit-to-visit measurements is associated with developing ACS. (Anatol J Cardiol 2019; 22: 112-6)

Anahtar Kelime:

Kardiyak Sendrom X Tanılı Hastalarda Artmış Ventriküler Aktivasyon Zamanı

Öz:

Giriş: Kardiyak sendrom X (KSX) noninvaziv stres testlerinde tespit edilebilen iskemi olmasına rağmen koroner anjiyografide koroner arter stenozu bulgularının olmadığı tipik anjina olarak tanımlanmaktadır. Bozulmuş koroner mikrosirkülasyon, inflamasyon ve endotel disfonksiyonu KSX için kabul edilmiş etyolojik faktörlerdir. Ventriküler aktivasyon zamanının (VAZ) miyokardiyal iskemi durumunda Purkinje liflerinde ve miyositlerdeki iletim yavaşlamasına bağlı olarak uzadığı bildirilmiştir. Bu çalışmada, KSX hastalarında aralarında VAZ’ın da bulunduğu elektrokardiyografik parametrelerin araştırılması amaçlanmıştır. Hastalar ve Yöntem: Çalışmaya KSX tanısı alan 120 hasta (ortalama yaş: 54.7 ± 8.6 yıl , erkek: 53) ile iskemisi olmayan 130 sağlıklı kontrol (ortalama yaş: 53.3 ± 8.9 yıl , erkek: 66) dahil edildi. Tüm hastalar elektrokardiyografi ve transtorasik ekokardiyografi ile değerlendirildi. VAZ elektrokardiyografide QRS kompleksinin başlangıcından R veya R’ dalgasının zirvesine kadar geçen zaman aralığı olarak tanımlandı. Bulgular: KSX hastaları ile kontrol grubu arasında demografik, laboratuvar ve ekokardiyografik parametreler açısından anlamlı bir fark izlenmedi. Elektrokardiyografik parametreler karşılaştırıldığında gruplar arasında kalp hızı, P dalga süresi, PR aralığı, QT ve düzeltilmiş QT aralığı açısından anlamlı fark yok iken, QRS süresi (95.1 ± 13.8 ve 90.4 ± 12.7 msn, p= 0.006) ve VAZ (34.8 ± 5.7 ve 29.2 ± 5.6 msn, p< 0.001) KSX grubunda anlamlı olarak daha uzun olarak tespit edildi. Sonuç: Bu çalışmada KSX hastalarında QRS süresi ve VAZ’ın anlamlı olarak uzadığı gösterilmiştir. Bu uzama KSX hastalarındaki bozulmuş mikrovasküler perfüzyon ve iskemiye bağlı iletim yavaşlamasına bağlı gelişmiş olabilir.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

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APA	KALÇIK M, TAHER Z, Bayam E, KHAYYAT W, GÜNER A, BALUBAİD M, Yesin M, TASHKANDİ M, Yetim M, KHAYYAT H, Doğan T, Kinsara P, BEKAR L, ÇELİK O, KARAVELİOĞLU Y (2019). Increased Ventricular Activation Time in Patients with the Diagnosis of Cardiac Syndrome X. , 145 - 151. 10.5578/khj.68492
Chicago	KALÇIK Macit,TAHER Ziad A.,Bayam Emrah,KHAYYAT Waleed W.,GÜNER AHMET,BALUBAİD Marwan M.,Yesin Mahmut,TASHKANDİ Mohamed Y.,Yetim Mucahit,KHAYYAT Haifaa A.,Doğan Tolga,Kinsara Prof. Abdulhalim,BEKAR Lütfü,ÇELİK OĞUZHAN,KARAVELİOĞLU Yusuf Increased Ventricular Activation Time in Patients with the Diagnosis of Cardiac Syndrome X. (2019): 145 - 151. 10.5578/khj.68492
MLA	KALÇIK Macit,TAHER Ziad A.,Bayam Emrah,KHAYYAT Waleed W.,GÜNER AHMET,BALUBAİD Marwan M.,Yesin Mahmut,TASHKANDİ Mohamed Y.,Yetim Mucahit,KHAYYAT Haifaa A.,Doğan Tolga,Kinsara Prof. Abdulhalim,BEKAR Lütfü,ÇELİK OĞUZHAN,KARAVELİOĞLU Yusuf Increased Ventricular Activation Time in Patients with the Diagnosis of Cardiac Syndrome X. , 2019, ss.145 - 151. 10.5578/khj.68492
AMA	KALÇIK M,TAHER Z,Bayam E,KHAYYAT W,GÜNER A,BALUBAİD M,Yesin M,TASHKANDİ M,Yetim M,KHAYYAT H,Doğan T,Kinsara P,BEKAR L,ÇELİK O,KARAVELİOĞLU Y Increased Ventricular Activation Time in Patients with the Diagnosis of Cardiac Syndrome X. . 2019; 145 - 151. 10.5578/khj.68492
Vancouver	KALÇIK M,TAHER Z,Bayam E,KHAYYAT W,GÜNER A,BALUBAİD M,Yesin M,TASHKANDİ M,Yetim M,KHAYYAT H,Doğan T,Kinsara P,BEKAR L,ÇELİK O,KARAVELİOĞLU Y Increased Ventricular Activation Time in Patients with the Diagnosis of Cardiac Syndrome X. . 2019; 145 - 151. 10.5578/khj.68492
IEEE	KALÇIK M,TAHER Z,Bayam E,KHAYYAT W,GÜNER A,BALUBAİD M,Yesin M,TASHKANDİ M,Yetim M,KHAYYAT H,Doğan T,Kinsara P,BEKAR L,ÇELİK O,KARAVELİOĞLU Y "Increased Ventricular Activation Time in Patients with the Diagnosis of Cardiac Syndrome X." , ss.145 - 151, 2019. 10.5578/khj.68492
ISNAD	KALÇIK, Macit vd. "Increased Ventricular Activation Time in Patients with the Diagnosis of Cardiac Syndrome X". (2019), 145-151. https://doi.org/10.5578/khj.68492

APA	KALÇIK M, TAHER Z, Bayam E, KHAYYAT W, GÜNER A, BALUBAİD M, Yesin M, TASHKANDİ M, Yetim M, KHAYYAT H, Doğan T, Kinsara P, BEKAR L, ÇELİK O, KARAVELİOĞLU Y (2019). Increased Ventricular Activation Time in Patients with the Diagnosis of Cardiac Syndrome X. Koşuyolu Heart Journal, 22(3), 145 - 151. 10.5578/khj.68492
Chicago	KALÇIK Macit,TAHER Ziad A.,Bayam Emrah,KHAYYAT Waleed W.,GÜNER AHMET,BALUBAİD Marwan M.,Yesin Mahmut,TASHKANDİ Mohamed Y.,Yetim Mucahit,KHAYYAT Haifaa A.,Doğan Tolga,Kinsara Prof. Abdulhalim,BEKAR Lütfü,ÇELİK OĞUZHAN,KARAVELİOĞLU Yusuf Increased Ventricular Activation Time in Patients with the Diagnosis of Cardiac Syndrome X. Koşuyolu Heart Journal 22, no.3 (2019): 145 - 151. 10.5578/khj.68492
MLA	KALÇIK Macit,TAHER Ziad A.,Bayam Emrah,KHAYYAT Waleed W.,GÜNER AHMET,BALUBAİD Marwan M.,Yesin Mahmut,TASHKANDİ Mohamed Y.,Yetim Mucahit,KHAYYAT Haifaa A.,Doğan Tolga,Kinsara Prof. Abdulhalim,BEKAR Lütfü,ÇELİK OĞUZHAN,KARAVELİOĞLU Yusuf Increased Ventricular Activation Time in Patients with the Diagnosis of Cardiac Syndrome X. Koşuyolu Heart Journal, vol.22, no.3, 2019, ss.145 - 151. 10.5578/khj.68492
AMA	KALÇIK M,TAHER Z,Bayam E,KHAYYAT W,GÜNER A,BALUBAİD M,Yesin M,TASHKANDİ M,Yetim M,KHAYYAT H,Doğan T,Kinsara P,BEKAR L,ÇELİK O,KARAVELİOĞLU Y Increased Ventricular Activation Time in Patients with the Diagnosis of Cardiac Syndrome X. Koşuyolu Heart Journal. 2019; 22(3): 145 - 151. 10.5578/khj.68492
Vancouver	KALÇIK M,TAHER Z,Bayam E,KHAYYAT W,GÜNER A,BALUBAİD M,Yesin M,TASHKANDİ M,Yetim M,KHAYYAT H,Doğan T,Kinsara P,BEKAR L,ÇELİK O,KARAVELİOĞLU Y Increased Ventricular Activation Time in Patients with the Diagnosis of Cardiac Syndrome X. Koşuyolu Heart Journal. 2019; 22(3): 145 - 151. 10.5578/khj.68492
IEEE	KALÇIK M,TAHER Z,Bayam E,KHAYYAT W,GÜNER A,BALUBAİD M,Yesin M,TASHKANDİ M,Yetim M,KHAYYAT H,Doğan T,Kinsara P,BEKAR L,ÇELİK O,KARAVELİOĞLU Y "Increased Ventricular Activation Time in Patients with the Diagnosis of Cardiac Syndrome X." Koşuyolu Heart Journal, 22, ss.145 - 151, 2019. 10.5578/khj.68492
ISNAD	KALÇIK, Macit vd. "Increased Ventricular Activation Time in Patients with the Diagnosis of Cardiac Syndrome X". Koşuyolu Heart Journal 22/3 (2019), 145-151. https://doi.org/10.5578/khj.68492