Cardıac repolarızatıon alteratıons ın patıents wıth hypoxıc braın ınjury

Tıpta Uzmanlık TeziVentriküler aritmileri ve ani kardiyak ölüm riskini saptamak için noninvaziv incelemelerin önemi son dönemde giderek artan ilgi görmektedir. Çeşitli elektrokardiyografik repolarizasyon indekslerinin sağlıklı bireylerde prognoz belirlemede önemli oldukları bilinmektedir. Kalp hızındaki artış QT mesafesini kısaltmaktadır. Bu nedenle bir takım formüller geliştirilmiş ve hıza göre düzeltilmiş QT (QTc) mesafesinin belirlenmesi amaçlanmıştır. Çalışmaya daha önce rapor edilmiş bir dizi kalp hızı QT düzeltme formülünün uygunluğunu test etmek için 24 saatlik EKG holter monitorizasyonu uygulanan 40 adet İskemik-Hipoksik Ensefalopati hastası alınmıştır. Hastalarda en hızlı ve en yavaş kalp hızlarında alınan QT, JT, JTa, TaTe gibi Ventriküler repolarizasyon parametreleri alındı. Alınan bu repolarizasyon parametreleri belirlenen 5 farklı kalp hızı düzeltme formülü ile düzeltilerek formüller arasında korelasyon analizi yapıldı. Fridericia yöntemi en hızlı ve en yavaş kalp hızlarında kalp hızından daha az etkilenen QT (419 ± 51 msn, 451 ± 49 msn) ve TaTe (103 ± 33 msn, 115 ± 23 msn) sonucunu vermekte idi. Diğer repolarizasyon parametreleri JT (292 ± 50 msn, 309 ± 38 msn) ve JTa (198 ± 33 msn, 201 ± 53 msn) göz önüne alındığında Framingham formülü en doğru sonucu vermekte idi. Bazzet ve Nomogram formülü ile hesaplanan ventriküler repolarizasyon parametreleri özellikle yüksek kalp hızlarında diğer formüllere göre daha uzun değerler vermekteydi. Nomogram formülü ise 60-100/dk gibi dar bir kalp hızı aralığında güvenli sonuçlar vermekte idi. Bu çalışmada bugün için en yaygın kullanılan Bazzet formülü, kalp hızına göre ventriküler repolarizasyon parametrelerini düzeltmede yetersiz kalmaktadır. Onun yerine kalp hızından en az etkilenen Fridericia'nın küp kök formülü QT ve TaTe mesafesi hesaplanırken kullanılması ve daha önce kullanılmayan JT ve JTa gibi diğer ventriküler repolarizasyon parametrelerini kalp hızına göre düzelten formüller arasında Framingham formülünün tercih edilmesinin daha güvenilir sonuçlar vereceğini düşünüyoruzAbstractNoninvasive procedures to determine the risk of sudden cardiac death and ventricular arythmia are recently under focus with increasing importance. It is already known that certain electrocardiographic repolarization indexes are essential to assess the prognosis in healthy subjects. The increase in heart rate causes to shorten the QT interval. Therefore, some formulae are developed to determine the corrected for heart rate QT interval (QTc). 40 patients with ischemic-hypoxic brain injury were enrolled and underwent a 24 hour ambulatory ECG holter monitorization to check the relevance of a previously reported QT correction for heart rate formula. Ventricular repolarization parameters such as QT, JT, JTa, Ta Te were determined at the highest and lowest heart rates. These repolarization parameters were corrected with five distinct correction formulae and corelation analysis were performed on the results. Fridericia method was observed to give the least affected QT (419 ± 51 msec, 451 ± 49 msec) and Ta Te (103 ± 33 msec, 115 ± 23 msec) results from the highest and the lowest heart rates. On regard to the other repolarization parameters JT JT (292 ± 50 msec, 309 ± 38 msec) and JTa (198 ± 33 msec, 201 ± 53 msec) Framingham method was observed to give the most accurate results. The ventricular repolarization parameters determined with Bazzet and Nomogram methods were observed to give longer results especially with higher heart rates than other methods. Nomogram method was observed to give confident results in narrow heart rate corridors such as 60-100/min. In this study, Bazzet method, the most common method is observed to remain inadequate to correct the ventricular repolarization parameters for the heart rate. Instead, we suggest the use of Fridericia?s cube root method for the determination of QT and Ta Te since it is the least effected method from the heart rate alterations, while Framingham method which was previously disused, to determine the other ventricular repolarization parameters such as JT and JTa for more confident result

To What Extent are We Applying Current Medical Treatment Approaches in Coronary Artery Disease?

29th Turkish Cardiology Congress of the Turkish-Society-of-Cardiology (TSC) with International Participation -- OCT 26-29, 2013 -- Antalya, TURKEYWOS: 000329858400516…Turkish Soc Cardio

Comparison of the TIMI Frame Count in Dipper and Non-Dipper Hypertensive Patients with Normal Coronary Arteries

29th Turkish Cardiology Congress of the Turkish-Society-of-Cardiology (TSC) with International Participation -- OCT 26-29, 2013 -- Antalya, TURKEYWOS: 000329858400450…Turkish Soc Cardio

Comparison of the TIMI Frame Count in Dipper and Non-Dipper Hypertensive Patients with Normal Coronary Arteries

29th Turkish Cardiology Congress of the Turkish-Society-of-Cardiology (TSC) with International Participation -- OCT 26-29, 2013 -- Antalya, TURKEYWOS: 000329858400450…Turkish Soc Cardio

Comparison of Five QT Correction Methods in Patients with Hypoxic Brain Injury

29th Turkish Cardiology Congress of the Turkish-Society-of-Cardiology (TSC) with International Participation -- OCT 26-29, 2013 -- Antalya, TURKEYWOS: 000329858400365…Turkish Soc Cardio

Chest pain score: a novel and practical approach to angina pectoris. A diagnostic accuracy study

ABSTRACT BACKGROUND: The chest pain classifications that are currently in use are based on studies that are several decades old. Various studies have indicated that these classifications are not sufficient for determining the origin of chest pain without additional diagnostic tests or tools. We describe a new chest pain scoring system that examines the relationship between chest pain and ischemic heart disease (IHD). DESIGN AND SETTING: Cross-sectional study conducted in a tertiary-level university hospital and two public hospitals. METHODS: Chest pain scores were assigned to 484 patients. These patients then underwent a treadmill stress test, followed by myocardial perfusion scintigraphy if necessary. Coronary angiography was then carried out on the patients whose tests had been interpreted as positive for ischemia. Afterwards, the relationship between myocardial ischemia and the test score results was investigated. RESULTS: The median chest pain score was 2 (range: 0-7) among the patients without IHD and 6 (1-8) among those with IHD. The median score of patients with IHD was significantly higher than that of patients without IHD (P = 0.001). Receiver operating characteristic analysis showed that the score had sensitivity of 97% and specificity of 87.5% for detecting IHD. CONCLUSION: We developed a pre-test chest pain score that uses a digital scoring system to assess whether or not the pain was caused by IHD. This scoring system can be applied easily and swiftly by healthcare professionals and can prevent the confusion that is caused by other classification and scoring systems