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

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.

Echocardiographic reference ranges for normal cardiac Doppler data in healthy Turkish population: ECHO-DOP-TR Trial

Aim Doppler echocardiography has become the standard imaging modality for diastolic function and provides pathophysiological insight into systolic and diastolic heart failure. In this study, we aimed to obtain normal echocardiographic Doppler parameters of healthy Turkish population. Methods Among 31 collaborating institutions from all regions of Turkey, 1154 healthy volunteers were enrolled in this study. Predefined protocols were used for all participants during echocardiographic examination and The American Society of Echocardiography and European Association of Cardiovascular Imaging recommendations were used for echocardiographic Doppler measurements. Results A total of 967 healthy participants were enrolled in this study after applying exclusion criteria. Echocardiographic examination was obtained from all subjects following predefined protocols. Mitral E wave velocity andE/Aratio were higher in females and decreased progressively in advancing ages. E wave deceleration time and A wave velocity were increased with aging. Assessment of tissue Doppler velocities showed that left ventricular laterale ', septale ', and septals ' were higher in younger subjects and in females.E/e ' ratio was increased progressively with advancing decades. Right ventriculare ' ands ' were decreased buta ' was increased with increasing age. Septale ' lower than 8 cm/s was 1.9% in the fifth decade and 13.7% in ages older than 50 years. TheE/e ' ratio greater than 15 (and also 13) was not found. Conclusion This study, for the first time, provides echocardiographic reference ranges for normal cardiac Doppler data in healthy Turkish population which will be useful in routine clinical practice as well as in future clinical trials

Echocardiographic reference ranges for normal cardiac Doppler data in healthy Turkish population: ECHO‐DOP‐TR Trial

Aim Doppler echocardiography has become the standard imaging modality for diastolic function and provides pathophysiological insight into systolic and diastolic heart failure. In this study, we aimed to obtain normal echocardiographic Doppler parameters of healthy Turkish population. Methods Among 31 collaborating institutions from all regions of Turkey, 1154 healthy volunteers were enrolled in this study. Predefined protocols were used for all participants during echocardiographic examination and The American Society of Echocardiography and European Association of Cardiovascular Imaging recommendations were used for echocardiographic Doppler measurements. Results A total of 967 healthy participants were enrolled in this study after applying exclusion criteria. Echocardiographic examination was obtained from all subjects following predefined protocols. Mitral E wave velocity andE/Aratio were higher in females and decreased progressively in advancing ages. E wave deceleration time and A wave velocity were increased with aging. Assessment of tissue Doppler velocities showed that left ventricular laterale ', septale ', and septals ' were higher in younger subjects and in females.E/e ' ratio was increased progressively with advancing decades. Right ventriculare ' ands ' were decreased buta ' was increased with increasing age. Septale ' lower than 8 cm/s was 1.9% in the fifth decade and 13.7% in ages older than 50 years. TheE/e ' ratio greater than 15 (and also 13) was not found. Conclusion This study, for the first time, provides echocardiographic reference ranges for normal cardiac Doppler data in healthy Turkish population which will be useful in routine clinical practice as well as in future clinical trials