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Frontal QRS-T Açısı İle Ambulatuar 24 Saat Holterde Prematür Ventriküler Kontraksiyon Yükü Arasındaki İlişki

Yıl 2022, Cilt: 6 Sayı: 2, 200 - 206, 20.08.2022

Görkem Kuş Göksel Çağırcı

https://doi.org/10.30565/medalanya.1131541

Öz

Amaç: Sık prematür ventriküler kontraksiyonlar (PVK), ventriküler fonksiyonun bozulmasına veya ventriküler kavitelerin genişlemesine neden olabilir. Frontal düzlem QRS-T [f(QRS-T)] açısı, miyokardın elektrofizyolojik özelliklerindeki kararsızlığın bir göstergesidir ve aritmilerle ilişkilidir. Bu çalışma, ventriküler repolarizasyon heterojenitesinin bir belirteci olarak f(QRS-T) açısının, ambulatuar 24 saatlik holterde prematüre ventriküler kasılma yükünü tahmin edip etmediğini araştırmayı amaçlamıştır.

Yöntem: Çalışmada 100 hasta mevcuttu. Hastalar 24 saatlik Holter izleminde PVK yüklerine göre “sık PVK” ve “nadir PVK” olarak iki gruba ayrıldı. Laboratuar ve frontal plan QRS-T açısı dahil olmak üzere bazı ambulatuar elektrokardiyografi parametreleri iki grup arasında karşılaştırıldı.

Bulgular: Frontal QRS-T açısı (63.34±37.86°’ye karşı 23.46±14.29° p<0.001) Sık PVK grubunda daha geniş bulundu. F(QRS-T) açısının ≥ 34° olması; PVK yükünü göstermede %82.2 duyarlılığa ve %80 özgüllüğe sahipti (AUC: 0.887 (0.824-0.950). Ayrıca PVK yükü ile f(QRS-T) açısı arasında pozitif korelasyon bulundu (r:0.429 p<0.001).

Sonuç: F(QRS-T) açısının genişlemesi, 24 saatlik Holter izleminde artmış PVK yükünün bir göstergesi olarak düşünülebilir. 12 derivasyonlu EKG'de PVK’sı olan hastalarda f(QRS-T) açısının ölçülmesi, artmış PVK yükü için uyarıcı bir bulgu olabilir.

Anahtar Kelimeler

prematür ventriküler kontraksiyon elektrokardiyografi frontal QRS-T açısı

Kaynakça

  • 1. Saurav A, Smer A, Abuzaid A, Bansal O, Abuissa H. Premature Ventricular Contraction Induced Cardiomyopathy. Clin. Cardiol. 2015; 38, 4, 251–58 DOI: 10.1002/clc.22371
  • 2. Kennedy HL, Whitlock JA, Sprague MK, Kennedy LJ, Buckingham TA, Goldberg RJ. Longterm follow-up of asymptomatic healthy subjects with frequent and complex ventricular ectopy. N Engl J Med 1985;312:193–97. DOI: 10.1056/NEJM198501243120401
  • 3. Dukes JW, Dewland TA, Vittinghoff E, Mandyam MC , Heckbert SR , Siscovick DS et al. Ventricular ectopy as a predictor of heart failure and death. J. Am. Coll. Cardiol. 2015; 66(2), 101–09 DOI: 10.1016/j.jacc.2015.04.062
  • 4. Shvilkin A, Anter E. Cardiomyopathy-inducing premature ventricular contractions: not all animals are equal? Heart Rhythm 2012;9(9),1473–74. DOI: 10.1016/j.hrthm.2012.06.027
  • 5. Latchamsetty R, Bogun F. Premature ventricular complex induced cardiomyopathy. Rev. Esp. Cardiol. (Engl. Ed.). 2016;69(4), 365–369 DOI: 10.1016/j.rec.2015.12.015
  • 6. Lin C-Y, Chang S-L, Lin Y-J, Lo Li-W , Chung F-P, Chen Y-Y et al. Long-term outcome of multiform premature ventricular complexes in structurally normal heart. International Journal of Cardiology 2015;180:80-85. DOI: 10.1016/j.ijcard.2014.11.110.
  • 7. Ruberman W, Weinblatt E, Goldberg JD, Frank C W, Chaudhary B S, Shapiro S et al. Ventricular premature complexes and sudden death after myocardial infarction. Circulation 1981; 64(2): 297-305. DOI: 10.1161/01.cir.64.2.297
  • 8. Macfarlane PW. The frontal plane QRS-T angle. Europace. 2012;14(6):773–75. DOI: 10.1093/europace/eus057
  • 9. Oehler A, Feldman T, Henrikson CA, Tereshchenko LG. QRS-T angle: a review. Ann Noninvasive Electrocardiol. 2014;19(6):534–42. DOI: 10.1111/anec.12206
  • 10. Aro AL, Huikuri HV, Tikkanen JT, Junttila MJ, Rissanen HA, Reunanenet A al. QRS-T angle as a predictor of sudden cardiac death in a middle-aged general population. Europace. 2012;14(6):872–76. DOI: 10.1093/europace/eur393
  • 11. Raposeiras-Roubin S, Virgos-Lamela A, Bouzas-Cruz N, López-López A , Castiñeira-Busto M, Fernández-Garda R et al. Usefulness of the QRS-T angle to improve long-term risk stratification of patients with acute myocardial infarction and depressed left ventricular ejection fraction. Am J Cardiol. 2014; 113(8):1312–1319. DOI: 10.1016/j.amjcard.2014.01.406
  • 12. Jogu HR, O'Neal WT, Broughton ST, Shah AJ, Zhang Z-M, Solimanet EZ al. Frontal QRS-T angle and the risk of atrial fibrillation in the elderly. Ann Noninvasive Electrocardiol. 2017;22(2):e12388. DOI: 10.1111/anec.12388
  • 13. Lazzeroni D, Bini M, Camaiora U, Castiglioni P, Moderato L, Ugolotti TP et al. Prognostic value of frontal QRS-T angle in patients undergoing myocardial revascularization or cardiac valve surgery. J Electrocardiol. 2018;51(6):967-972. DOI: 10.1016/j.jelectrocard.2018.08.028
  • 14. Baman TS, Lange DC, Ilg KJ, Gupta SK, Liu TY, Alguire C et al. Relationship between burden of premature ventricular complexes and left ventricular function. Heart Rhythm 2010;7(7):865-9. DOI: 10.1016/j.hrthm.2010.03.036
  • 15. Zhang ZM, Rautaharju PM, Prineas RJ, Tereshchenko L, Soliman EZ. Electrocardiographic QRS-T angle and the risk of incident silent myocardial infarction in the Atherosclerosis Risk in Communities study. J Electrocardiol. 2017;50(5):661–666. DOI: 10.1016/j.jelectrocard.2017.05.001
  • 16. Massing MW, Simpson RJ Jr, Rautaharju PM, Schreiner P J, Crow R, Heiss G. Usefulness of ventricular premature complexes to predict coronary heart disease events and mortality (from the Atherosclerosis Risk in Communities Cohort). Am J Cardiol 2006;98:1609e12. DOI: 10.1016/j.amjcard.2006.06.061
  • 17. Agarwal SK, Simpson RJ Jr, Rautaharju P, Alonso A, , Shahar EC, Massing M et al. Relation of ventricular premature complexes to heart failure (from the Atherosclerosis Risk In Communities [ARIC] study). Am. J. Cardiol. 2012;109(1), 105–109. DOI: 10.1016/j.amjcard.2011.08.009
  • 18. Glancy JM, Weston PJ, Bhullar HK, Garratt CJ, Woods KL, de Bono DP. Reproducibility and automatic measurement of QT dispersion. Eur Heart J. 1996;17:1035-1039. DOI: 10.1093/oxfordjournals.eurheartj.a014999
  • 19. Malik M, Acar B, Gang Y, Yap YG, Hnatkova K, Camm AJ. QT dispersion does not represent electrocardiographic interlead heterogeneity of ventricular repolarization. J Cardiovasc Electrophysiol 2000;11(8):835–43. DOI: 10.1111/j.1540-8167.2000.tb00061.x
  • 20. Hevia JC, Castro Hevia J, Antzelevitch C, Sánchez MD, Balea FD, Molina RZ et al. Tpeak-Tend and Tpeak-Tend Dispersion as Risk Factors for Ventricular Tachycardia/Ventricular Fibrillation in Patients With the Brugada Syndrome. Journal of the American College of Cardiology 2006; 2;47(9):1828-1834. DOI:10.1016/j. jacc.2005.12.049
  • 21. Yayla Ç, Özcan F, Aras D, Turak O, Özeke Ö, Çay S et al. Tp-e interval and Tp-e/QT ratio before and after catheter ablation in patients with premature ventricular complexes. Biomark Med. 2017;11(4):339-46. DOI: 10.2217/bmm-2016-0263
  • 22. Antzelevitch C, Sicouri S, Di Diego JM, Burashnikov A, Viskin S, Shimizu W et al. Does Tpeak-Tend provide an index of transmural dispersion of repolarization? Heart Rhythm. 2007;4(8):1114–1116. Author reply 6–9. DOI: 10.1016/j.hrthm.2007.05.028
  • 23. Kardys I, Kors JA, van der Meer IM, Hofman A, van der Kuip DA, Witteman JC. Spatial QRS‐T angle predicts cardiac death in a general population. European Heart Journal. 2003;24, 1357–1364. DOI: 10.1016/s0195-668x(03)00203-3
  • 24. Zhang ZM, Prineas RJ, Case D, Soliman EZ, Rautaharju PM et al. Comparison of the prognostic significance of the electrocardiographic QRS/T angles in predicting incident coronary heart disease and total mortality (from the atherosclerosis risk in communities study). Am J Cardiol.2007;100(5):844–849. DOI: 10.1016/j.amjcard.2007.03.104
  • 25. Loring Z, Hanna P, Pellegrini CN. Longer ambulatory ECG monitoring increases the identification of clinically significant ectopy. Pacing Clin Electrophysiol. 2016;39:592–597. DOI: 10.1111/pace.12852

The relationship between frontal QRS-T angle and premature ventricular contraction burden in ambulatory 24-hour Holter

Yıl 2022, Cilt: 6 Sayı: 2, 200 - 206, 20.08.2022

Görkem Kuş Göksel Çağırcı

https://doi.org/10.30565/medalanya.1131541

Öz

Aim: Frequent premature ventricular contractions (PVCs) can cause impaired ventricular function or dilatation of ventricular cavities. The frontal plane QRS-T [f(QRS-T)] angle is an indicator of instability in the electrophysiological properties of the myocardium and is associated with arrhythmias. The present study aimed to investigate whether f(QRS-T) angle, as a marker of ventricular repolarization heterogeneity, predicts premature ventricular contraction burden in ambulatory 24-hour Holter.

Methods: The study included 100 patients. The patients were divided into two groups as ‘frequent PVC’ and ‘seldom PVC’ according to their PVC burden in 24-hour Holter monitoring. Laboratory and some ambulatory electrocardiography parameters, including frontal plane QRS-T angle, were compared between the two groups.

Results: Frontal QRS-T angle (63.34±37.86° vs 23.46±14.29° p<0.001) was found to be wider in the Frequent PVC group. F(QRS-T) angle of ≥ 34° had a sensitivity of 82.2% and a specificity of 80% in indicating PVC load (AUC: 0.887 (0.824-0.950). In addition, a positive correlation was found between PVC burden and f(QRS-T) angle (r:0.429 p<0.001).

Conclusion: The widening of f(QRS-T) angle could perhaps be considered as a surrogate marker of increased PVC burden in 24-hour Holter monitoring. Measuring f(QRS-T) angle in 12-lead ECG in patients with PVC may be a warning sign for increased PVC burden.

Anahtar Kelimeler

premature ventricular contraction electrocardiography frontal QRS-T angle

Kaynakça

  • 1. Saurav A, Smer A, Abuzaid A, Bansal O, Abuissa H. Premature Ventricular Contraction Induced Cardiomyopathy. Clin. Cardiol. 2015; 38, 4, 251–58 DOI: 10.1002/clc.22371
  • 2. Kennedy HL, Whitlock JA, Sprague MK, Kennedy LJ, Buckingham TA, Goldberg RJ. Longterm follow-up of asymptomatic healthy subjects with frequent and complex ventricular ectopy. N Engl J Med 1985;312:193–97. DOI: 10.1056/NEJM198501243120401
  • 3. Dukes JW, Dewland TA, Vittinghoff E, Mandyam MC , Heckbert SR , Siscovick DS et al. Ventricular ectopy as a predictor of heart failure and death. J. Am. Coll. Cardiol. 2015; 66(2), 101–09 DOI: 10.1016/j.jacc.2015.04.062
  • 4. Shvilkin A, Anter E. Cardiomyopathy-inducing premature ventricular contractions: not all animals are equal? Heart Rhythm 2012;9(9),1473–74. DOI: 10.1016/j.hrthm.2012.06.027
  • 5. Latchamsetty R, Bogun F. Premature ventricular complex induced cardiomyopathy. Rev. Esp. Cardiol. (Engl. Ed.). 2016;69(4), 365–369 DOI: 10.1016/j.rec.2015.12.015
  • 6. Lin C-Y, Chang S-L, Lin Y-J, Lo Li-W , Chung F-P, Chen Y-Y et al. Long-term outcome of multiform premature ventricular complexes in structurally normal heart. International Journal of Cardiology 2015;180:80-85. DOI: 10.1016/j.ijcard.2014.11.110.
  • 7. Ruberman W, Weinblatt E, Goldberg JD, Frank C W, Chaudhary B S, Shapiro S et al. Ventricular premature complexes and sudden death after myocardial infarction. Circulation 1981; 64(2): 297-305. DOI: 10.1161/01.cir.64.2.297
  • 8. Macfarlane PW. The frontal plane QRS-T angle. Europace. 2012;14(6):773–75. DOI: 10.1093/europace/eus057
  • 9. Oehler A, Feldman T, Henrikson CA, Tereshchenko LG. QRS-T angle: a review. Ann Noninvasive Electrocardiol. 2014;19(6):534–42. DOI: 10.1111/anec.12206
  • 10. Aro AL, Huikuri HV, Tikkanen JT, Junttila MJ, Rissanen HA, Reunanenet A al. QRS-T angle as a predictor of sudden cardiac death in a middle-aged general population. Europace. 2012;14(6):872–76. DOI: 10.1093/europace/eur393
  • 11. Raposeiras-Roubin S, Virgos-Lamela A, Bouzas-Cruz N, López-López A , Castiñeira-Busto M, Fernández-Garda R et al. Usefulness of the QRS-T angle to improve long-term risk stratification of patients with acute myocardial infarction and depressed left ventricular ejection fraction. Am J Cardiol. 2014; 113(8):1312–1319. DOI: 10.1016/j.amjcard.2014.01.406
  • 12. Jogu HR, O'Neal WT, Broughton ST, Shah AJ, Zhang Z-M, Solimanet EZ al. Frontal QRS-T angle and the risk of atrial fibrillation in the elderly. Ann Noninvasive Electrocardiol. 2017;22(2):e12388. DOI: 10.1111/anec.12388
  • 13. Lazzeroni D, Bini M, Camaiora U, Castiglioni P, Moderato L, Ugolotti TP et al. Prognostic value of frontal QRS-T angle in patients undergoing myocardial revascularization or cardiac valve surgery. J Electrocardiol. 2018;51(6):967-972. DOI: 10.1016/j.jelectrocard.2018.08.028
  • 14. Baman TS, Lange DC, Ilg KJ, Gupta SK, Liu TY, Alguire C et al. Relationship between burden of premature ventricular complexes and left ventricular function. Heart Rhythm 2010;7(7):865-9. DOI: 10.1016/j.hrthm.2010.03.036
  • 15. Zhang ZM, Rautaharju PM, Prineas RJ, Tereshchenko L, Soliman EZ. Electrocardiographic QRS-T angle and the risk of incident silent myocardial infarction in the Atherosclerosis Risk in Communities study. J Electrocardiol. 2017;50(5):661–666. DOI: 10.1016/j.jelectrocard.2017.05.001
  • 16. Massing MW, Simpson RJ Jr, Rautaharju PM, Schreiner P J, Crow R, Heiss G. Usefulness of ventricular premature complexes to predict coronary heart disease events and mortality (from the Atherosclerosis Risk in Communities Cohort). Am J Cardiol 2006;98:1609e12. DOI: 10.1016/j.amjcard.2006.06.061
  • 17. Agarwal SK, Simpson RJ Jr, Rautaharju P, Alonso A, , Shahar EC, Massing M et al. Relation of ventricular premature complexes to heart failure (from the Atherosclerosis Risk In Communities [ARIC] study). Am. J. Cardiol. 2012;109(1), 105–109. DOI: 10.1016/j.amjcard.2011.08.009
  • 18. Glancy JM, Weston PJ, Bhullar HK, Garratt CJ, Woods KL, de Bono DP. Reproducibility and automatic measurement of QT dispersion. Eur Heart J. 1996;17:1035-1039. DOI: 10.1093/oxfordjournals.eurheartj.a014999
  • 19. Malik M, Acar B, Gang Y, Yap YG, Hnatkova K, Camm AJ. QT dispersion does not represent electrocardiographic interlead heterogeneity of ventricular repolarization. J Cardiovasc Electrophysiol 2000;11(8):835–43. DOI: 10.1111/j.1540-8167.2000.tb00061.x
  • 20. Hevia JC, Castro Hevia J, Antzelevitch C, Sánchez MD, Balea FD, Molina RZ et al. Tpeak-Tend and Tpeak-Tend Dispersion as Risk Factors for Ventricular Tachycardia/Ventricular Fibrillation in Patients With the Brugada Syndrome. Journal of the American College of Cardiology 2006; 2;47(9):1828-1834. DOI:10.1016/j. jacc.2005.12.049
  • 21. Yayla Ç, Özcan F, Aras D, Turak O, Özeke Ö, Çay S et al. Tp-e interval and Tp-e/QT ratio before and after catheter ablation in patients with premature ventricular complexes. Biomark Med. 2017;11(4):339-46. DOI: 10.2217/bmm-2016-0263
  • 22. Antzelevitch C, Sicouri S, Di Diego JM, Burashnikov A, Viskin S, Shimizu W et al. Does Tpeak-Tend provide an index of transmural dispersion of repolarization? Heart Rhythm. 2007;4(8):1114–1116. Author reply 6–9. DOI: 10.1016/j.hrthm.2007.05.028
  • 23. Kardys I, Kors JA, van der Meer IM, Hofman A, van der Kuip DA, Witteman JC. Spatial QRS‐T angle predicts cardiac death in a general population. European Heart Journal. 2003;24, 1357–1364. DOI: 10.1016/s0195-668x(03)00203-3
  • 24. Zhang ZM, Prineas RJ, Case D, Soliman EZ, Rautaharju PM et al. Comparison of the prognostic significance of the electrocardiographic QRS/T angles in predicting incident coronary heart disease and total mortality (from the atherosclerosis risk in communities study). Am J Cardiol.2007;100(5):844–849. DOI: 10.1016/j.amjcard.2007.03.104
  • 25. Loring Z, Hanna P, Pellegrini CN. Longer ambulatory ECG monitoring increases the identification of clinically significant ectopy. Pacing Clin Electrophysiol. 2016;39:592–597. DOI: 10.1111/pace.12852
Toplam 25 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri, İç Hastalıkları
Bölüm Araştırma Makalesi
Yazarlar

Görkem Kuş 0000-0002-6058-5501

Göksel Çağırcı 0000-0001-9768-918X

Erken Görünüm Tarihi 20 Ağustos 2022
Yayımlanma Tarihi 20 Ağustos 2022
Gönderilme Tarihi 16 Haziran 2022
Kabul Tarihi 19 Temmuz 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 6 Sayı: 2

Kaynak Göster

Vancouver Kuş G, Çağırcı G. The relationship between frontal QRS-T angle and premature ventricular contraction burden in ambulatory 24-hour Holter. Acta Med. Alanya. 2022;6(2):200-6.

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