The importance of fragmented QRS complexes in prediction of myocardial infarction and reperfusion parameters in patients undergoing primary percutaneous coronary intervention

Öz:

Amaç: Başvuru elektrokardiyogramlarında (EKG) sıklıkla görülen, dar ya da geniş QRS yapısı olan QRS kompleks fragmantasyonları (fQRS) artmış morbidite ve mortalite ile ilişkilidir. FQRS ve kardiyak fibroz arasındaki sebepsel ilişki bilinmektedir, fakat primer perkütan koroner girişim (p-PKG) öncesi ve sonrası fQRSnin miyokart enfarktüsü ve reperfüzyon parametreleri ile ilişkisi şimdiye kadar incelenmedi. Çalışma planı: Çalışmaya p-PKGye giden 184 ardışık ST yükselmeli miyokart enfarktüslü (STEMI) hasta alındı. p-PKG öncesi ve sonrası EKGlerde fQRS varlığı ya da yokluğu ve p-PKG ile fQRS değişimi araştırıldı. Ek olarak, fQRSin bağımsız öngörücüleri ayrıca araştırıldı. Anlamlı organik kapak hastalığı olan, 120 ms ve üzerinde QRS süresi olan ve de kalıcı kalp pili olan hastalar çalışmadan dışlandı. Bulgular: Başvuru EKGsinde fQRSi olan hastalar olmayan hastalar ile karşılaştırıldığında daha yüksek lökosit sayılarına (p=0.001), daha yüksek CK-MB (p=0.001) ve troponin (p=0.005) düzeylerine, uzamış ağrı balon sürelerine (p=0.004), daha yüksek Killip skorlarına (p<0.001), uzamış QRS süresine (p<0.001), daha yüksek Gensini skoru (p<0.001) ve EKGde daha sık Q dalgasına sahipti. Ek olarak, bu hastalar proksimal LADde bir lezyon ile ilişkili anteriyor bölge enfarktüsü ve daha geniş tehdit altında bir miyokarda sahipti (p<0.001). fQRS, p-PKG öncesinde ve sonrasında enfarktüs ve miyokardiyal reperfüzyon ile anlamlı bir şekilde ilişkiliydi. STEMI seyrinde başvuru EKGsinde fQRSin yokluğu artmış ST rezolüsyonunu, QRS süresinde daha belirgin bir azalma ve daha iyi bir miyokart reperfüzyonunu öngördü. Sonuç: FQRS daha büyük tehdit altındaki iskemik ya da nekroze olmuş miyokardı olan yüksek kardiyak riskteki hastaların tanımlanmasında yararlı olabilir.

Anahtar Kelime:

Konular: Kalp ve Kalp Damar Sistemi

Primer perkütan koroner girişime giden hastalarda miyokart enfarktüsü ve reperfüzyon parametrelerinin öngörülmesinde fragmante olmuş QRS komplekslerin önemi

Öz:

Objectives: The QRS complex fragmentations (fQRS) fre- quently seen on admission electrocardiograms (ECGs) with narrow or wide QRS complex are associated with increased morbidity and mortality. The causative relationship between fQRS and cardiac fibrosis is known, but the relation of frag- mented QRS before and after primary percutaneous coro- nary intervention (p-PCI) with myocardial infarction and re- perfusion parameters has not been studied until now. Study design: The study included 184 consecutive patients with ST elevation myocardial infarction (STEMI) who under- went p-PCI. Presence or absence of fQRS on pre- and post- PCI ECGs and its change following PCI were investigated. In addition, independent predictors of fQRS were also in- vestigated. Patients with significant organic valve disease and patients having any QRS morphology with QRS dura- tion ≥120 ms as well as patients with permanent pacemak- ers were excluded from the study. Results: Patients with fQRS on admission ECG had higher eukocyte counts (p=0.001), higher CK-MB (p=0.001) and troponin levels (p=0.005), increased pain to balloon time (p=0.004), higher Killip score (p<0.001), prolonged QRS time (p<0.001), higher Gensini score (p<0.001) and more frequent Q waves on ECG (p<0.001) in comparison to pa- tients with non-fragmented QRS. In addition, these patients usually had an infarction of anterior territory related to a le- sion in proximal LAD and wider jeopardized myocardium (p<0.001). fQRS was significantly related to infarction and myocardial reperfusion parameters before and after p-PCI. In the setting of STEMI, absence of fQRS on admission ECG predicted increased ST resolution, higher reduction in QRS duration, and better myocardial reperfusion. Conclusion: FQRS may be useful in identifying patients at higher cardiac risk with larger areas of ischemic jeopardized or necrotic myocardium.

Anahtar Kelime:

Konular: Kalp ve Kalp Damar Sistemi

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

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APA	KOCAMAN S, ÇETİN M, KIRIŞ T, ERDOĞAN T, ÇANĞA A, Durakoglugil M, ŞATIROĞLU Ö, ŞAHİNARSLAN A, çiçek y, sahin i, BOSTAN M (2012). The importance of fragmented QRS complexes in prediction of myocardial infarction and reperfusion parameters in patients undergoing primary percutaneous coronary intervention. , 213 - 222.
Chicago	KOCAMAN Sinan Altan,ÇETİN Mustafa,KIRIŞ TUNCAY,ERDOĞAN Turan,ÇANĞA Aytun,Durakoglugil Murtaza Emre,ŞATIROĞLU Ömer,ŞAHİNARSLAN Asiye,çiçek yüksel gülen,sahin ismail,BOSTAN Mehmet The importance of fragmented QRS complexes in prediction of myocardial infarction and reperfusion parameters in patients undergoing primary percutaneous coronary intervention. (2012): 213 - 222.
MLA	KOCAMAN Sinan Altan,ÇETİN Mustafa,KIRIŞ TUNCAY,ERDOĞAN Turan,ÇANĞA Aytun,Durakoglugil Murtaza Emre,ŞATIROĞLU Ömer,ŞAHİNARSLAN Asiye,çiçek yüksel gülen,sahin ismail,BOSTAN Mehmet The importance of fragmented QRS complexes in prediction of myocardial infarction and reperfusion parameters in patients undergoing primary percutaneous coronary intervention. , 2012, ss.213 - 222.
AMA	KOCAMAN S,ÇETİN M,KIRIŞ T,ERDOĞAN T,ÇANĞA A,Durakoglugil M,ŞATIROĞLU Ö,ŞAHİNARSLAN A,çiçek y,sahin i,BOSTAN M The importance of fragmented QRS complexes in prediction of myocardial infarction and reperfusion parameters in patients undergoing primary percutaneous coronary intervention. . 2012; 213 - 222.
Vancouver	KOCAMAN S,ÇETİN M,KIRIŞ T,ERDOĞAN T,ÇANĞA A,Durakoglugil M,ŞATIROĞLU Ö,ŞAHİNARSLAN A,çiçek y,sahin i,BOSTAN M The importance of fragmented QRS complexes in prediction of myocardial infarction and reperfusion parameters in patients undergoing primary percutaneous coronary intervention. . 2012; 213 - 222.
IEEE	KOCAMAN S,ÇETİN M,KIRIŞ T,ERDOĞAN T,ÇANĞA A,Durakoglugil M,ŞATIROĞLU Ö,ŞAHİNARSLAN A,çiçek y,sahin i,BOSTAN M "The importance of fragmented QRS complexes in prediction of myocardial infarction and reperfusion parameters in patients undergoing primary percutaneous coronary intervention." , ss.213 - 222, 2012.
ISNAD	KOCAMAN, Sinan Altan vd. "The importance of fragmented QRS complexes in prediction of myocardial infarction and reperfusion parameters in patients undergoing primary percutaneous coronary intervention". (2012), 213-222.

APA	KOCAMAN S, ÇETİN M, KIRIŞ T, ERDOĞAN T, ÇANĞA A, Durakoglugil M, ŞATIROĞLU Ö, ŞAHİNARSLAN A, çiçek y, sahin i, BOSTAN M (2012). The importance of fragmented QRS complexes in prediction of myocardial infarction and reperfusion parameters in patients undergoing primary percutaneous coronary intervention. Türk Kardiyoloji Derneği Arşivi, 40(3), 213 - 222.
Chicago	KOCAMAN Sinan Altan,ÇETİN Mustafa,KIRIŞ TUNCAY,ERDOĞAN Turan,ÇANĞA Aytun,Durakoglugil Murtaza Emre,ŞATIROĞLU Ömer,ŞAHİNARSLAN Asiye,çiçek yüksel gülen,sahin ismail,BOSTAN Mehmet The importance of fragmented QRS complexes in prediction of myocardial infarction and reperfusion parameters in patients undergoing primary percutaneous coronary intervention. Türk Kardiyoloji Derneği Arşivi 40, no.3 (2012): 213 - 222.
MLA	KOCAMAN Sinan Altan,ÇETİN Mustafa,KIRIŞ TUNCAY,ERDOĞAN Turan,ÇANĞA Aytun,Durakoglugil Murtaza Emre,ŞATIROĞLU Ömer,ŞAHİNARSLAN Asiye,çiçek yüksel gülen,sahin ismail,BOSTAN Mehmet The importance of fragmented QRS complexes in prediction of myocardial infarction and reperfusion parameters in patients undergoing primary percutaneous coronary intervention. Türk Kardiyoloji Derneği Arşivi, vol.40, no.3, 2012, ss.213 - 222.
AMA	KOCAMAN S,ÇETİN M,KIRIŞ T,ERDOĞAN T,ÇANĞA A,Durakoglugil M,ŞATIROĞLU Ö,ŞAHİNARSLAN A,çiçek y,sahin i,BOSTAN M The importance of fragmented QRS complexes in prediction of myocardial infarction and reperfusion parameters in patients undergoing primary percutaneous coronary intervention. Türk Kardiyoloji Derneği Arşivi. 2012; 40(3): 213 - 222.
Vancouver	KOCAMAN S,ÇETİN M,KIRIŞ T,ERDOĞAN T,ÇANĞA A,Durakoglugil M,ŞATIROĞLU Ö,ŞAHİNARSLAN A,çiçek y,sahin i,BOSTAN M The importance of fragmented QRS complexes in prediction of myocardial infarction and reperfusion parameters in patients undergoing primary percutaneous coronary intervention. Türk Kardiyoloji Derneği Arşivi. 2012; 40(3): 213 - 222.
IEEE	KOCAMAN S,ÇETİN M,KIRIŞ T,ERDOĞAN T,ÇANĞA A,Durakoglugil M,ŞATIROĞLU Ö,ŞAHİNARSLAN A,çiçek y,sahin i,BOSTAN M "The importance of fragmented QRS complexes in prediction of myocardial infarction and reperfusion parameters in patients undergoing primary percutaneous coronary intervention." Türk Kardiyoloji Derneği Arşivi, 40, ss.213 - 222, 2012.
ISNAD	KOCAMAN, Sinan Altan vd. "The importance of fragmented QRS complexes in prediction of myocardial infarction and reperfusion parameters in patients undergoing primary percutaneous coronary intervention". Türk Kardiyoloji Derneği Arşivi 40/3 (2012), 213-222.