Korean Circulation Journal

  • 제46권4호
  • /
  • Pages.522-529
  • /
  • 2016
  • /
  • 1738-5520(pISSN)
  • /
  • 1738-5555(eISSN)
대한심장학회 (The Korean Society of Cardiology)
권호 표지
DOI QR코드

DOI QR Code

The Relationship between P & QT Dispersions and Presence & Severity of Stable Coronary Artery Disease

  • Sahin, Bingul Dilekci (Department of Cardiology, Erzurum Region Training and Research Hospital) ;
  • Yildirim, Erkan (Department of Cardiology, Erzurum Region Training and Research Hospital) ;
  • Ipek, Emrah (Department of Cardiology, Erzurum Region Training and Research Hospital) ;
  • Cengiz, Mahir (Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University) ;
  • Aslan, Kursat (Department of Cardiology, Erzurum Region Training and Research Hospital) ;
  • Poyraz, Esra (Department of Cardiology, Istanbul Siyami Ersek Training and Research Hospital) ;
  • Demirelli, Selami (Department of Cardiology, Erzurum Region Training and Research Hospital) ;
  • Bayantemur, Murat (Department of Cardiology, Erzurum Region Training and Research Hospital) ;
  • Ermis, Emrah (Department of Cardiology, Erzurum Region Training and Research Hospital) ;
  • Ciftci, Cavlan (Department of Cardiology, Istanbul Bilim University)
  • 투고 : 2015.08.08
  • 심사 : 2015.12.01
  • 발행 : 2016.07.30
⟨ 이전 논문 다음 논문 ⟩

초록

Background and Objectives: The study aimed to evaluate the correlation between electrocardiographic (ECG) parameters and presence and extent of coronary artery disease (CAD) to indicate the usefulness of these parameters as predictors of severity in patients with stable CAD. Subjects and Methods: Two hundred fifty patients, without a history of any cardiovascular event were included in the study. The ECG parameters were measured manually by a cardiologist before coronary angiography. The patients were allocated into five groups: those with normal coronary arteries (Group 1), non-critical coronary lesions (Group 2), one, two and three vessel disease (Group 3, Group 4 and Group 5, respectively. Results: Group 1 had the lowest P wave dispersion (PWD) and P wave (Pmax), QT interval (QTmax), QT dispersion (QTd), corrected QT dispersion (QTcd) and QT dispersion ratio (QTdR), while the patients in group 5 had the highest values of these parameters. Gensini score and QTmax, QTd, QTcmax, QTcd, QTdR, Pmax, and PWD were positively correlated. QTdR was the best ECG parameter to differentiate group 1 and 2 from groups with significant stenosis (groups 3, 4, and 5) (area under curve [AUC] 0.846). QTdR was the best ECG parameter to detect coronary arterial narrowing lesser than 50% and greater than 50%, respectively (AUC 0.858). Conclusion: Presence and severity of CAD can be determined by using ECG in patients with stable CAD and normal left ventricular function.

키워드

참고문헌

  1. Napoli C, Glass CK, Witztum JL, Deutsch R, D'Armiento FP, Palinski W. Influence of maternal hypercholesterolemia during pregnancy on progression of early atherosclerotic lesions in childhood: Fate of Early Lesions in Children (FELIC) study. Lancet 1999;354:1234-41. https://doi.org/10.1016/S0140-6736(99)02131-5
  2. Task Force Members, Montalescot G, Sechtem U, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 2013;34:2949-3003. https://doi.org/10.1093/eurheartj/eht296
  3. Dilaveris PE, Gialafos EJ, Sideris SK, et al. Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J 1998;135(5 Pt 1):733-38. https://doi.org/10.1016/S0002-8703(98)70030-4
  4. Day CP, McComb LM, Campbell RW. QT dispersion: an indication of arrhythmia risk in patients with long QT intervals. Br Heart J 1990;63:342-4. https://doi.org/10.1136/hrt.63.6.342
  5. Savelieva I, Camm AJ, Malik M. Gender-specific differences on QT dispersion measured in 1100 healthy subjects. (abstr). PACE 1999;22:885.
  6. Higham PD, Furniss SS, Campbell RW. QT dispersion and components of the QT interval in ischemia and infarction. Br Heart J 1995;73:32-6. https://doi.org/10.1136/hrt.73.1.32
  7. Glancy JM, Garrat CJ, de Bono DP. Dynamics of QT dispersion during myocardial infarction and ischemia. Int J Cardiol 1996;57:55-60. https://doi.org/10.1016/S0167-5273(96)02732-5
  8. Sporton SC, Taggart P, Sutton PM, Walker JM, Hardman SM. Acute ischemia: a dynamic influence on QT dispersion. Lancet 1997;349:306-9. https://doi.org/10.1016/S0140-6736(96)06143-0
  9. Beaubien ER, Pylypchuk GB, Akhtar J, Biem HJ. Value of corrected QT interval dispersion in identifying patients initiating dialysis at increased risk of total and cardiovascular mortality. Am J Kidney Dis 2002;39:834-42. https://doi.org/10.1053/ajkd.2002.32005
  10. Naas AA, Davidson NC, Thompson C, et al. QT and QTc dispersion are accurate predictors of cardiac death in newly diagnosed non-insulin-dependent diabetes: cohort study. BMJ 1998;316:745-6. https://doi.org/10.1136/bmj.316.7133.745
  11. Malik M, Batchvarov VN. Measurement, interpretation, and clinical potential of QT dispersion. J Am Coll Cardiol 2000;36:1749-66. https://doi.org/10.1016/S0735-1097(00)00962-1
  12. Emond M, Mock MB, Davis KB, et al. Long-term survival of medically treated patients in the Coronary Artery Surgery Study (CASS) registry. Circulation 1994;90:2645-57. https://doi.org/10.1161/01.CIR.90.6.2645
  13. Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol 1983;51:606. https://doi.org/10.1016/S0002-9149(83)80105-2
  14. Tunstall-Pedoe H, Kuulasmaa K, Amouyel P, Arveiler D, Rajakangas AM, Pajak A. Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation 1994;90:583-612. https://doi.org/10.1161/01.CIR.90.1.583
  15. Kannel WB, Doyle JT, McNamara PM, Quickenton P, Gordon T. Precursors of sudden coronary death. Factors related to the incidence of sudden death. Circulation 1975;51:606-13. https://doi.org/10.1161/01.CIR.51.4.606
  16. Risk stratification and survival after myocardial infarction. N Engl J Med 1983;309:331-6. https://doi.org/10.1056/NEJM198308113090602
  17. Sanz G, Castaner A, Betriv A, et al. Determinants of prognosis in survivors of myocardial infarction: a prospective clinical angiographic study. N Engl J Med 1982;306:1065-70. https://doi.org/10.1056/NEJM198205063061801
  18. Hull SS Jr, Evans AR, Vanoli E, et al. Heart rate variability before and after myocardial infarction in conscious dogs at high and low risk of sudden death. J Am Coll Cardiol 1990;16:978-85. https://doi.org/10.1016/S0735-1097(10)80351-1
  19. Kautzner J, Malik M. QT interval dispersion and its clinical utility. Pacing Clin Electrophysiol 1997;20:2625-40. https://doi.org/10.1111/j.1540-8159.1997.tb06112.x
  20. Day CP, McComb JM, Campell RW. QT dispersion: an indication of arrhytmia risk in patients with long QT intervals. Br Heart J 1990;63:342-4. https://doi.org/10.1136/hrt.63.6.342
  21. Day CP, McComb JM, Campell RW. QT dispersion in sinus beats and ventricular extrasystoles in normal hearts. Br Heart J 1992;67:39-41. https://doi.org/10.1136/hrt.67.1.39
  22. Elming H, Holm E, JunL, et al. The prognostic value of the QT interval and QT interval dispersion in all-cause and cardiac mortality and morbidity in a population of Danish citizens. Eur Heart J 1998;19:1391-400. https://doi.org/10.1053/euhj.1998.1094
  23. Akyuz A, Alpsoy S, Akkoyun DC, Degirmenci H, Guler N. Maximal exercise-corrected QT as a predictor of coronary artery disease: comparison of simpler heart rate corrections. Korean Circ J 2013;43:655-63. https://doi.org/10.4070/kcj.2013.43.10.655
  24. Elsasser A, Schlepper M, Klovekorn WP, et al. Hibernating myocardium: an incomplete adaptation to ischemia. Circulation 1997;96:2920-31. https://doi.org/10.1161/01.CIR.96.9.2920
  25. Zareba W, Moss AJ, le Cessie S. Dispersion of ventricular repolarization and arrhythmic death in coronary artery disease. Am J Cardiol 1994;74:550-3. https://doi.org/10.1016/0002-9149(94)90742-0
  26. Batur MK, Aksoyek S, Oto A, et al. Circadian variations of QTc dispersion: is it a clue to morning increase of sudden cardiac death? Clin Cardiol 1999;22:103-6. https://doi.org/10.1002/clc.4960220209
  27. Lowe MD, Rowland E, Grace AA. QT dispersion and triple vessel coronary disease. Lancet 1997;349:1175-6. https://doi.org/10.1016/S0140-6736(05)63054-1
  28. Sporton SC, Taggart P, Sutton PM, Walker JM, Hardman SM. Acute ischemia: a dynamic influence on QT dispersion. Lancet 1997;349:306-9. https://doi.org/10.1016/S0140-6736(96)06143-0