Yıl: 2012 Cilt: 12 Sayı: 7 Sayfa Aralığı: 576 - 583 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery

Öz:
Amaç: Fragmente olmuş QRS kompleksleri (fQRS) bir majör koroner arter bölgesine karşılık gelen 2 ardışık derivasyonda çeşitli RSR' paternleri olarak tanımlanılmaktadır. FQRS ve kardiyak olaylar arasında miyokardiyal fibrozisin sebepsel ilişkisi ortaya konulmuş olsa da, izole koroner arter baypass greftleme cerrahisi (KABG) yapılan hastalarda sık ve ciddi bir komplikasyon olan postoperatif atriyal fibrilasyon (POAF) için fQRSin öngörücü rolü şimdiye kadar araştırılmamıştır. Bundan dolayı bu ilişki çalışmamızda incelendi. Yöntemler: Çalışma gözlemsel yapılı olarak düzenlendi. İzole KABG cerrahisine giden, çalışma kriterlerine uygun 272 hasta ardışık olarak çalışmaya dahil edildi. Hastalar postoperatif atriyal fibrilasyon (AF)u olan ve olmayan olmak üzere iki gruba ayrıldı. KABG cerrahisini takiben yeni başlangıçlı AF gelişimi ve fQRS ile ilişkisi araştırıldı. Lojistik regresyon analizi POAFyi öngören bağımsız değişkenlerin belirlenilmesinde kullanıldı. Çalışma parametrelerinin POAFyi öngörmedeki duyarlılık ve özgüllükleri ROC eğrisi altında kalan alan ile hesaplandı. Bulgular: POAF 272 hastanın 62sinde (%22.8) gelişti. POAFlı hastalar AFsiz hastalar ile karşılaştırıldığında, genellikle daha yaşlı (p<0.001) ve bayandı (p=0.006). Bu grupta hipertansiyon (p=0.008), düşük hemoglobin düzeyi (p=0.011), kronik obstruktif akciğer hastalığı (p=0.003), uzamış QRS süresi (p=0.004) ve yüksek EUROSCORE (p<0.001) daha sık saptandı. POAFlı hastalar daha düşük sol ventrikül ejeksiyon fraksiyonu ve daha yüksek fQRS oranları sergilerken (p<0.001), benzer sol atriyal çapa sahiptiler (p>0.05). İlgi çekici bir bulgu sol atriyum boyutunun fQRSli hastalarda artmış olmasıydı (3.8±0.6 vs. 4.1±0.5 cm, p=0.002). Ek olarak, POAFlı hastalar daha uzun kardiyak cerrahi yoğun bakım ünitesi yatışına (p<0.001) ve uzamış hastane içi bakım sürelerine gereksinim duydular (p=0.001). Yeni başlangıçlı POAF, fQRS varlığı ve sayısı ile istatistiksel olarak anlamlı bir ilişkiye sahipti. Lojistik regresyon analizinde, sadece yaş (OR: 1.044, %95 GA: 1.008-1.082, p=0.016), kadın cinsiyet (OR: 2.347, %95 GA: 1.079-5.106, p=0.031), fQRSin varlığı ve sayısı bağımsızdır (OR: 6.020, %95 GA: 3.152-11.5 and OR: 1.522, %95 GA: 1.282-1.807, her ikisi için de; p<0.001). POAF gelişimi için bağımsız etkenlerdi. Operasyon öncesi elektrokardiyogram üzerindeki fQRSin varlığının POAFı öngörmedeki duyarlılığı, özgüllüğü, pozitif öngörücü değeri, negatif öngörücü değeri ve tanısal kesinliği sırasıyla %66, %76, %45, %88 ve %74 idi. ROC eğrisi altındaki alan 0.733 (p<0.001, %95 GA: 0.657- 0.810) olarak belirlendi. Sonuç: Bu çalışmada yeni başlangıçlı POAF, KABG cerrahisi yapılan hastalarda fQRSin varlığı ve sayısı ile bağımsız anlamlı bir ilişkiye sahipti. Ek olarak, operasyon öncesi yüzey EKGsi üzerindeki fQRS olması yeni başlangıçlı POAF gelişimi için yüksek öngörücülük değerlerine sahipti. (Anadolu Kardiyol Derg 2012; 12: 576-83)
Anahtar Kelime:

Konular: Kalp ve Kalp Damar Sistemi

Fragmente QRS izole koroner arter baypass greftleme operasyonu geçiren hastalarda postoperatif atriyal fibrilasyon gelişimini öngörebilir

Öz:
Objective: Fragmented QRS complexes (fQRS) are defined as various RSR&#8242; patterns in 2 contiguous leads corresponding to a major coronary artery territory. Although the reason of association between fQRS and cardiac events was documented as cardiac fibrosis, the predictive role of fQRS was not studied for postoperative atrial fibrillation (POAF) which is a frequent and serious complication in patients undergoing isolated coronary artery bypass graft (CABG) surgery. Therefore, this issue was investigated in the present study. Methods: The current study has a prospective observational design. Two hundred and seventy two eligible patients who underwent isolated CABG surgery were enrolled consecutively. The patients were divided in two groups with post-op atrial fibrillation (AF) and non-AF. The occurrence of new-onset AF following CABG and the relationship with fQRS were searched. The logistic regression analysis was used to determine independent predictors for POAF. The sensitivity and specificity of study variables in predicting POAF were calculated using a receiver-operating characteristic curve (ROC). Results: POAF occurred in 62 of 272 patients (22.8%). Patients with POAF were generally older (p<0.001) and female (p=0.006), with preexisting hypertension (p=0.008), lower hemoglobin levels (p=0.011), chronic obstructive lung disease (p=0.003), prolonged QRS time (p=0.004), and higher EUROSCORE (p<0.001) compared to non-AF patients. Patients with POAF had lower left ventricular ejection fraction (p<0.001) and high fQRS rate (p<0.001), but similar left atrial size (LA, p=NS). Interestingly, LA size was significantly enlarged in patients with fQRS (3.8±0.6 vs. 4.1±0.5 cm, p=0.002). In addition, the patients with POAF had prolonged stay in the cardiac surgery intensive-care unit (p<0.001) and extended in-hospital care (p=0.001). New-onset POAF was significantly related to the presence and number of fQRS. In the logistic regression analysis, only age (OR: 1.044, 95% CI: 1.008-1.082, p=0.016), female gender (OR: 2.347, 95% CI: 1.079-5.106, p=0.031), the presence and number of fQRS (OR: 6.020, 95% CI: 3.152-11.5 and OR: 1.522, 95% CI: 1.282-1.807, both of, p<0.001) were independent predictors of POAF. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and the diagnostic accuracy (DA) of presence of fQRS on pre-op electrocardiogram to predict POAF were 66%, 76%, 45%, 88% and 74%, respectively. The area under ROC was found as 0.733 (p<0.001, 95% CI: 0.657-0.810). Conclusion: In our study, we found that new-onset POAF was independently related to the presence and number of fQRS in patients undergoing CABG surgery. In addition, fQRS on pre-op surface ECG had high predictive values for new-onset POAF. (Anadolu Kardiyol Derg 2012; 12: 576-83)
Anahtar Kelime:

Konular: Kalp ve Kalp Damar Sistemi
Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
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APA ÇETİN M, KOCAMAN S, ERDOĞAN T, DURAKOĞLUGİL M, çiçek y, Bozok Ş, ÇANĞA A, TEMİZ A, DOĞAN S, ŞATIROĞLU Ö (2012). Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery. , 576 - 583.
Chicago ÇETİN Mustafa,KOCAMAN Sinan Altan,ERDOĞAN Turan,DURAKOĞLUGİL Murteza Emre,çiçek yüksel gülen,Bozok Şahin,ÇANĞA Aytun,TEMİZ Ahmet,DOĞAN Sıtkı,ŞATIROĞLU Ömer Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery. (2012): 576 - 583.
MLA ÇETİN Mustafa,KOCAMAN Sinan Altan,ERDOĞAN Turan,DURAKOĞLUGİL Murteza Emre,çiçek yüksel gülen,Bozok Şahin,ÇANĞA Aytun,TEMİZ Ahmet,DOĞAN Sıtkı,ŞATIROĞLU Ömer Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery. , 2012, ss.576 - 583.
AMA ÇETİN M,KOCAMAN S,ERDOĞAN T,DURAKOĞLUGİL M,çiçek y,Bozok Ş,ÇANĞA A,TEMİZ A,DOĞAN S,ŞATIROĞLU Ö Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery. . 2012; 576 - 583.
Vancouver ÇETİN M,KOCAMAN S,ERDOĞAN T,DURAKOĞLUGİL M,çiçek y,Bozok Ş,ÇANĞA A,TEMİZ A,DOĞAN S,ŞATIROĞLU Ö Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery. . 2012; 576 - 583.
IEEE ÇETİN M,KOCAMAN S,ERDOĞAN T,DURAKOĞLUGİL M,çiçek y,Bozok Ş,ÇANĞA A,TEMİZ A,DOĞAN S,ŞATIROĞLU Ö "Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery." , ss.576 - 583, 2012.
ISNAD ÇETİN, Mustafa vd. "Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery". (2012), 576-583.
APA ÇETİN M, KOCAMAN S, ERDOĞAN T, DURAKOĞLUGİL M, çiçek y, Bozok Ş, ÇANĞA A, TEMİZ A, DOĞAN S, ŞATIROĞLU Ö (2012). Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery. Anadolu Kardiyoloji Dergisi, 12(7), 576 - 583.
Chicago ÇETİN Mustafa,KOCAMAN Sinan Altan,ERDOĞAN Turan,DURAKOĞLUGİL Murteza Emre,çiçek yüksel gülen,Bozok Şahin,ÇANĞA Aytun,TEMİZ Ahmet,DOĞAN Sıtkı,ŞATIROĞLU Ömer Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery. Anadolu Kardiyoloji Dergisi 12, no.7 (2012): 576 - 583.
MLA ÇETİN Mustafa,KOCAMAN Sinan Altan,ERDOĞAN Turan,DURAKOĞLUGİL Murteza Emre,çiçek yüksel gülen,Bozok Şahin,ÇANĞA Aytun,TEMİZ Ahmet,DOĞAN Sıtkı,ŞATIROĞLU Ömer Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery. Anadolu Kardiyoloji Dergisi, vol.12, no.7, 2012, ss.576 - 583.
AMA ÇETİN M,KOCAMAN S,ERDOĞAN T,DURAKOĞLUGİL M,çiçek y,Bozok Ş,ÇANĞA A,TEMİZ A,DOĞAN S,ŞATIROĞLU Ö Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery. Anadolu Kardiyoloji Dergisi. 2012; 12(7): 576 - 583.
Vancouver ÇETİN M,KOCAMAN S,ERDOĞAN T,DURAKOĞLUGİL M,çiçek y,Bozok Ş,ÇANĞA A,TEMİZ A,DOĞAN S,ŞATIROĞLU Ö Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery. Anadolu Kardiyoloji Dergisi. 2012; 12(7): 576 - 583.
IEEE ÇETİN M,KOCAMAN S,ERDOĞAN T,DURAKOĞLUGİL M,çiçek y,Bozok Ş,ÇANĞA A,TEMİZ A,DOĞAN S,ŞATIROĞLU Ö "Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery." Anadolu Kardiyoloji Dergisi, 12, ss.576 - 583, 2012.
ISNAD ÇETİN, Mustafa vd. "Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery". Anadolu Kardiyoloji Dergisi 12/7 (2012), 576-583.