Nermin BAYAR
(Antalya Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, Antalya, Türkiye)
Hasan Fatih ÇAY
(Antalya Eğitim ve Araştırma Hastanesi, Romatoloji Kliniği, Antalya, Türkiye)
(Antalya Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, Antalya, Türkiye)
(Antalya Eğitim ve Araştırma Hastanesi, Romatoloji Kliniği, Antalya, Türkiye)
(Antalya Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, Antalya, Türkiye)
(Antalya Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, Antalya, Türkiye)
Serkan ÇAY
(Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, Ankara, Türkiye)
(Antalya Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, Antalya, Türkiye)
(Antalya Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, Antalya, Türkiye)
Yıl: 2015Cilt: 15Sayı: 3ISSN: 2149-2263 / 2149-2271Sayfa Aralığı: 209 - 212İngilizce

127 0
The importance of fragmented QRS in the early detection of cardiac involvement in patients with systemic sclerosis
Objective: Systemic sclerosis (SSc) is an autoimmune connective tissue disorder characterized by fibrosis. The prognosis of the disease is bad when clinically symptomatic cardiac dysfunction is occurred, therefore early detection of cardiac dysfunction is important in patients with SSc. The aim of this study was to investigate the frequency of fQRS in superficial electrocardiography in cardiacally asymptomatic patients with SSc and its relation to the systolic pulmonary artery pressure (sPAP). Methods: This study included 31 cardiacally asymptomatic patients with SSc (23 females, 40.4±9.2 years) and 41 healthy volunteers as the control (31 females, 38.2±11.8 years). The ECGs with 12 derivations and transthoracic echocardiographies of the patients were evaluated. The presence of fQRS in the superficial ECG, and its relation to systolic pulmonary artery pressure (sPAP) were investigated. Results: The mean sPAP value in the SSc group was observed to be higher than that of the control group (26 mm Hg and 20 mm Hg, respec- tively, p<0.001). The presence of fQRS in the SSc group was more frequent than the control group (55% and 10%, respectively, p<0.001). In SSc patients presence of fQRS become relevant with ≥24 mm Hg sPAP by 88% sensitivity and 79% specificity. Conclusion: In our study, the presence of fQRS in SSc patients, were more frequent than in the normal population. Since pulmonary hyperten- sion is the primary cause of mortality in patients with SSc, the correlation of fQRS with sPAP should also be considered.
Fen > Tıp > Kalp ve Kalp Damar Sistemi
DergiAraştırma MakalesiErişime Açık
  • 1. Steen V. The heart in systemic sclerosis (review). Curr Rheumatol Rep 2004; 6: 137-40. [CrossRef]
  • 2. Kahan A, Allanore Y. Primary myocardial involvement in systemic sclerosis. Rheumatology (Oxford) 2006; 45: 14-7. [CrossRef]
  • 3. Tzelepis GE, Kelekis NL, Plastiras SC, Mitseas P, Economopoulos N, Kampolis C, et al. Pattern and distribution of myocardial fibrosis in systemic sclerosis: a delayed enhanced magnetic resonance imaging study. Arthritis Rheum 2007; 56: 3827-36. [CrossRef]
  • 4. Flowers NC, Horan LG, Thomas JR, Tolleson WJ. The anatomic basis for high,frequency components in the electrocardiogram. Circulation 1969; 39: 531-9. [CrossRef]
  • 5. Lesh MD, Spear JF, Simson MB. A computer model of the electrogram: what causes fractionation? J Electrocardiol 1988; 21: 69-73. [CrossRef]
  • 6. Friedman PL, Fenoqlio JJ, Wit AL. Time course for reversal of elec- trophysiological and ultrastructural abnormalities in subendocar- dial Purkinje fibers surviving extensive myocardial infarction in dogs. Circ Res 1975; 36: 127-44. [CrossRef]
  • 7. Wiener I, Mindich B, Pitchon R. Fragmented endocardial electrical activity in patients with ventricular tachycardia: a new guide to surgical therapy. Am Heart J 1984; 107: 86-90. [CrossRef]
  • 8. Başaran Y, Tigen K, Karaahmet T, Işıklar I, Çevik C, Gürel E, et al. Fragmented QRS complexes are associated with cardiac fibrosis and significant intraventricular systolic dyssynchrony in nonisch- emic dilated cardiomyopathy patients with a narrow QRS interval. Echocardiography 2011; 28: 62-8. [CrossRef]
  • 9. Das MK, Khan B, Jacob S, Kumar A, Mahenthiran J. Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease. Circulation 2006; 113: 2495-501. [CrossRef]
  • 10. Steen VD, Medsger TA Jr. Severe organ involvement in systemic scle- rosis with diffuse scleroderma. Arthritis Rheum 2000; 43: 2437-44. [CrossRef]
  • 11. Ferri C, Valentini G, Cozzi F, Sebastiani M, Michelassi C, La Montagna G, et al. Systemic sclerosis: demographic, clinical, and serologic features and survival in 1,012 Italian patients. Medicine (Baltimore) 2002; 81: 139-53. [CrossRef]
  • 12. Kahan A, Coghlan G, McLaughlin V. Cardiac complications of sys- temic sclerosis. Rheumatology (Oxford) 2009; 48: 45-8. [CrossRef]
  • 13. Cusmà-Piccione M, Zito C, Bagnato G, Oreto G, Di Bella G, Bagnato D, et al. Role of 2D strain in the early identification of left ventricu- lar dysfunction and in the risk stratification of systemic patients. Cardiovasc Ultrasound 2013; 11: 6. [CrossRef]
  • 14. Plastiras SC, Kelekis N, Tzelepis GE. Magnetic resonance imaging for the detection of myocardial fibrosis in scleroderma. N Engl J Med 2006; 354: 2194-6. [CrossRef]
  • 15. Allanore Y, Meune C, Kahan A. Systemic sclerosis and cardiac dysfunction: evolving concepts and diagnostic methodologies. Curr Opin Rheumatol 2008; 20: 697-702. [CrossRef]
  • 16. Ferri C, Giuggioli D, Sebastiani M, Colaci M, Emdin M. Heart involve- ment and systemic sclerosis. Lupus 2005; 14: 702-7. [CrossRef]
  • 17. Steen VD, Medgser TA Jr. Long-term outcomes of scleroderma renal crisis. Ann Intern Med 2000; 133: 600-3. [CrossRef]
  • 18. Kostis JB, Seibold JR, Turkevich D, Masi AT, Grau RG, Medsger TA Jr, et al. Prognostic importance of cardiac arrhythmias in systemic sclerosis. Am J Med 1988; 84: 1007-15. [CrossRef]
  • 19. Plastiras SC, Toumanidis ST. Systemic sclerosis: The heart of the matter. Hellenic J Cardiol 2012; 53: 287-300.
  • 20. Can I, Onat AM, Aytemir K, Akdoğan A, Üreten K, Kiraz S, et al. Assessment of atrial conduction in patients with scleroderma by tissue Doppler echocardiography and P wave dispersion. Cardiology 2007; 108: 317-21. [CrossRef]
  • 21. Pignone A, Matucci-Cerinic M, Becucci A, de Leonardis V, Lombardi A, Fabiani D, et al. Patterns of ventricular late potentials in systemic sclerosis: a noninvasive method in the study of cardiac involvement. Ann Ital Med Int 1994; 9: 141-5.
  • 22. Silver RM, Miller KS, Kinsella MB, Smith EA, Schabel SI. Evaluation and management of scleroderma lung disease using bronchoal- veolar lavage. Am J Med 1990; 88: 470-6. [CrossRef]
  • 23. Rubin LJ. Primary pulmonary hypertension. N Engl J Med 1997; 336: 111-7. [CrossRef]
  • 24. Barst RJ. Medical therapy of pulmonary hypertension: an overview of treatment and goals. Clin Chest Med 2001; 22: 509-15. [CrossRef]
  • 25. Simonneau G, Galie N, Rubin LJ, Langleben D, Seeger W, Domeninghetti G, et al. Clinical classification of pulmonary hyper- tension. J Am Coll Cardiol 2004; 43: 5-12. [CrossRef]
  • 26. Humbert M, Nunes H, Sitbon O, Parent F, Hervé P, Simonneau G. Risk factors for pulmonary arterial hypertension. Clin Chest Med 2001; 22: 459-75. [CrossRef]
  • 27. Runo JR, Loyd JE. Primary pulmonary hypertension. Lancet 2003; 361: 1533-44. [CrossRef]
  • 28. Serra W, Chetta A, Santilli D, Mozzani F, Dall’Aglio PP, Olivier D, et al. Echocardiography may help detect pulmonary vasculopathy in the early stages of pulmonary artery hypertension associated with systemic sclerosis. Cardiovasc Ultrasound 2010; 8: 25. [CrossRef]
  • 29. Kadı H, İnanır A, Habiboğlu A, Ceyhan K, Koç F, Çelik A, et al. Frequency of fragmented QRS on ECG is increased in patients with rheumatoid arthritis without cardiovascular disease: a pilot study. Mod Rheumatol 2012; 22: 238-42. [CrossRef]
  • 30. İnanır A, Ceyhan K, Okan S, Kadı H. Frequency of fragmented QRS in ankylosing spondylitis: a prospective controlled study. Z Rheumatol 2013; 72: 468-73. [CrossRef]

TÜBİTAK ULAKBİM Ulusal Akademik Ağ ve Bilgi Merkezi Cahit Arf Bilgi Merkezi © 2019 Tüm Hakları Saklıdır.