The role of the presence of fragmented QRS in predicting disease severity in patients with pulmonary hypertension

Pulmonary arterial hypertension is a malignant pulmonary vascular disease primarily caused by increased pulmonary vascular resistance, which leads to right ventricular hypertrophy, fibrosis, right heart failure and death. Fragmented QRS (fQRS) indicates non-homogeneous ventricular activity caused by myocardial fibrosis. This study aims to investigate the importance of fQRS in patients with pulmonary hypertension (PH) and to determine the role of the presence of fQRS in indicating the severity of the disease. The study included 94 (85 patient group 1 PH and 9 patient group 4 PH) patients. The patients were divided into two groups according to the presence of fQRS in their surface electrocardiography (ECG). The patients' laboratory, transthoracic echocardiography, and right heart catheterization parameters were compared between the two groups . FQRS was detected in 55 (58%) patients, and the mean age of these patients was 51.8±18.0, and 29.1% of them were male. Systolic pulmonary arterial pressure (PAP) measured by transthoracic echocardiography (p [Med-Science 2022; 11(4.000): 1619-24

Koroner arter hastalığının yaygınlığı ile aortik stiffnes ilişkisi

Amaç: Bu araştırmada, koroner arter hastalığının yaygınlığı ve ciddiyeti ile aortun elastikiyet özellikleri arasındaki ilişki araştırıldı. Yöntem ve gereç: Çalışmaya, koroner arter hastalığı (KAH) şüphesiyle elektif koroner anjiyografi yapılan ardışık yüz hasta alındı. Bunlardan KAH tespit edilen, yaş ortalamaları 62,1 ± 10,3 yıl olan 47 erkek, 16 kadın toplam 63 hasta grup 1 olarak alındı. Koroner arterleri normal ve yaş ortalamaları 51,4 ± 10,8 yıl olan 20 erkek, 17 kadın toplam 37 olgu grup 2 olarak alındı. Koroner anjiyografi sonrası tüm hastalara ekokardiyografi yapılarak aortun elastik özellikleri (aortik distensibilite ve stifness index) ölçüldü. Hastaların yaş, cinsiyet ve ateroskleroz risk faktörleri sorgulandı. Koroner anjiyografi de % 50’den fazla darlık olması ciddi koroner arter hastalığı olarak kabul edildi. Koroner arter hastalığının yaygınlığı gensini skoru ile belirlendi. Bulgular: Grup 1 deki hastaların yaş ortalamaları (62,1 ± 10,3 yıl) ve erkek cinsiyet oranı, grup 2’den (51,4 ± 10,8) daha fazla bulundu (sırasıyla P < 0.001, P = 0.035). Grup 1’in aortik stifnes ortalaması grup 2’ye göre anlamlı derecede artarken (sırasıyla, 8,9 ± 5,1 mm, 6,1 ± 4,6 mm, P = 0.001). aortik distensibilite ortalaması ise anlamlı derecede azalmış bulundu (sırasıyla, 23,4 ± 16,5 mm, 42,4 ± 27,1 mm, P < 0.001). İleri yaş, koroner arter hastalığı risk faktörleri ve koroner arter hastalığının yaygınlığı ile korele olarak aortik stifnes indeks artmakta, distensibilite azalmaktadır. Sonuç: KAH’ın yaygınlığı ve tutulan koroner damar sayısı ile orantılı olarak aortik stifnesi artmakta, distensibilite ise azalmaktadır.Aim: To investigate the relation between aortic stiffness and the extension/severity of coronary artery disease (CAD). Materials and methods: A consecutive 100 patients with suspicion of CAD who underwent elective coronary angiography were enrolled in this study. Of those patients determined as having CAD, 63 were classifi ed as Group I (mean age: 62.1 ± 10.3 years; 47 male and 16 female). Group II included 37 patients with normal coronary arteries (mean age: 51.4 ± 10.8 years; 20 male and 17 female). Aortic flexibility (aortic distensibility and stiffness index) was evaluated by echocardiography aft er coronary angiography in all of the patients. Patient data were gathered in relation to age, sex, and atherosclerotic risk factors. Stenosis above 50% was accepted as severe CAD. The extension of coronary artery disease was determined using the Gensini score. Results: The mean age (62.1 ± 10.3 and 51.4 ± 10.8, respectively) and the male/female rate in Group I were higher than in Group II (P < 0.001 and P = 0.035, respectively). The mean aortic stiffness in Group I was significantly increased compared to Group II (8.9 ± 5.1 mm and 6.1 ± 4.6 mm, respectively; P = 0.001), whereas the mean aortic distensibility in Group I was signifi cantly lower than in Group II (23.4 ± 16.5 mm and 42.4 ± 27.1 mm, respectively; P < 0.001). The aortic stiffness index increased and distensibility decreased in correlation with age, coronary artery risk factors, and extension of CAD. Conclusion: The aortic stiffness index increased and distensibility decreased in correlation with CAD extension and the number of affected coronary arteries

Znaczenie wyników elektrokardiografii w diagnozowaniu ubytku przegrody międzyprzedsionkowej

Background: Atrial septal defect (ASD) is the most frequent heart defect observed in adulthood. Although it is usually non-symptomatic, it may result in heart failure, arrhythmic complications, and paradoxical embolism-related morbidity or mortality if the diagnosis is late. Aim: This study was planned in order to investigate the importance of electrocardiographic findings in the diagnosis of ASD. Methods: Sixty-one patients with a diagnosis of ASD and 66 healthy volunteers without cardiac disease were enrolled in the study. Electrocardiographs (ECG) were performed on all patients to investigate the presence of right bundle branch block (RBBB), incomplete RBBB, defective T wave (DTW), and notch finding in the R wave of inferior derivations (crochetage R wave). ASD types and diameters were determined via transthoracic and transoesophageal echocardiography. Results: It was determined that incomplete RBBB (56% vs. 5%), DTW (48% vs. 3%), and R wave crochetage (57% vs. 8%) in inferior derivations were more frequent in ASD patients compared to the control group patients. The specificity of the defined ECG findings in the diagnosis of ASD were 95%, 97%, and 92%, respectively. No correlation was detected between the ASD diameter and incomplete RBBB, whereas significant correlation was observed between the ASD diameter and the presence of crochetage R wave (17.5 ± 4.0 mm in patients with crochetage R wave, and 20.9 ± 8.2 mm in patients without crochetage R wave, p = 0.057). Conclusions: Detection of RBBB, DTW, and crochetage R wave in superficial ECG may contribute to early detection in patients with ASD.  Wstęp: Ubytek przegrody międzyprzedsionkowej (ASD) jest najczęstszą wadą serca występującą u osób dorosłych. Zwykle nie powoduje ona objawów, lecz jeśli nie zostanie wcześnie rozpoznana, może być przyczyną niewydolności serca, zaburzeń rytmu i zatorów paradoksalnych oraz związanych z tym śmiertelności i chorobowości. Cel: Celem pracy była ocena znaczenia parametrów elektrokardiograficznych (EKG) w diagnozowaniu ASD. Metody: Do badania włączono 61 chorych z ASD i 66 osób zdrowych (bez chorób serca). U wszystkich pacjentów wykonano badanie EKG w celu sprawdzenia, czy występują: blok prawej odnogi pęczka Hisa (RBBB), niezupełny RBBB, nieprawidłowy załamek T (DTW) i wcięcia w załamku R w odprowadzeniach II, III i aVF (zazębiony załamek R). Typy i wymiary ASD określono za pomocą echokardiografii przezklatkowej i przezprzełykowej. Wyniki: Ustalono, że niezupełny RBBB (56% vs. 5%), DTW (48% vs. 3%) i zazębiony załamek R (57% vs. 8%) w odprowadzeniach II, III i aVF występowały częściej u chorych z ASD niż u osób z grupy kontrolnej. Swoistość określonych cech w EKG w stosunku do rozpoznania ASD wynosiła odpowiednio 95%, 97% i 92%. Nie wykazano żadnych korelacji między średnicą ASD a niezupełnym RBBB, stwierdzono natomiast istotne zależności między średnicą ASD a obecnością zazębionego załamka R (17,5 ± 4,0 mm u chorych z zazębionym załamkiem R i 20,9 ± 8,2 mm u pacjentów bez zazębienia załamka R; p = 0,057). Wnioski: Stwierdzenie RBBB, DTW i zazębionego załamka R w zapisie powierzchniowego EKG może się przyczynić do wczesnego wykrycia ASD.

Atrial electrical activity parameters of the study populations.

<p>Atrial electrical activity parameters of the study populations.</p