Kerem Can YILMAZ, Orçun ÇİFTCİ, Suzan KESKİN, İbrahim Haldun MÜDERRİSOĞLU, Emir KARAÇAĞLAR

Akut Pulmoner Tromboembolizm Tanısı ve Şiddetinin Belirlenmesinde Sağ Ventrikülü Gören Prekordiyal Derivasyonlar ve aVR’de İntrinsikoid Defleksiyon Zamanının Rolü

Amaç: Pulmoner tromboemboli (PTE), yüksek morbidite ve mortaliteye sahiptir. Masif ve submasif PTE’nin tanınması tedavinin yönlendirilmesiiçin önemlidir. İntrinsikoid defleksiyon zamanı, QRS kompleksinin başlangıcından R dalgası pikine kadar geçen süreyi ifade eder ve endokarddanepikarda olan iletinin yayılmasına karşılık gelir. Akut PTE tanısı ve ciddiyetinin sınıflandırılmasında henüz kullanılmamıştır. Bu çalışmada, intrinsikoiddefleksiyon zamanın (İDZ) akut PTE tanısı ve ciddiyetinin sınıflandırılmasında kullanımı araştırılmıştır.Gereç ve Yöntem: Bu çalışmaya Ocak 2012 ile Ocak 2017 tarihleri arasında Başkent Üniversitesi Hastanesi’ne akut pulmoner embolizm ön tanısı ilebaşvurmuş 89 hasta retrospektif olarak alındı. Otuz (%33,7) hastada pulmoner emboli yoktu, 30 (%33,7) hastada anjiyografik olarak masif olmayanve 29 (%32,6) hastada masif pulmoner emboli vardı. Klinik ciddiyet olarak 22 (%24,7) hafif pulmoner emboli, 31 (%34,8) submasif pulmoner embolive 6 (%6,7) masif pulmoner emboli vardı. On iki derivasyonlu elektrokardiyografide (EKG) V1, V2 ve VR’de İDZ emboli grubu ile olmayanlar arasındave pulmoner emboli şiddetine göre karşılaştırıldı. İDZ ile klinik, ekokardiyografik ve biyokimyasal parametreler korele edildi.Bulgular: PTE olmayan gruba göre, pulmoner emboli olan hastalarda, anjiyografik olarak masif ve non-masif PTE grubunda ve klinik olarak masifve submasif gruplarında V2 derivasyonunda İDZ anlamlı şekilde daha uzundu. Korelasyon analizlerinde V2 İDZ, PTE varlığı, anjiyografik ve klinikciddiyet, sağ ventrikül sistolik fonksiyonu ve sağ dal bloğu ile anlamlı ilişkiliydi.Sonuç: EKG’de V2 derivasyonunda uzamış İDZ PTE varlığı, sağ ventrikül disfonksiyonu, masif ve submasif PTE’nin göstergesidir. Bu parametreninprospektif ve daha fazla sayıda hasta içeren çalışmalarla incelenmesi gereklidir.

The Role of Intrinsicoid Deflection Time in Precordial Leads Facing Right Ventricle and aVR for Diagnosis of Acute Pulmonary Thromboembolism and Determination Its Severity

Objectives: Pulmonary thromboembolism (PTE) is associated with high morbidity and mortality. Recognition of massive and submassive PTE is important for management guidance. Intrinsicoid deflection time refers to the time from QRS onset to the peak of the R wave and corresponds to the spread of conduction from endocardium to epicardium. It has not been used for diagnosis and severity assessment of acute PTE. In this study the role of intrinsicoid deflection times (IDT) in the diagnosis and classification of prognosis of acute PTE. Materials and Methods: This study retrospectively included 89 patients who presented to Başkent University Hospital with symptoms compatible with PTE between January 2012 and January 2017. Thirty (33.7%) patients had no PTE, 30 (33.7%) had non-massive and 29 (32.6%) had massive PTE. Twenty (24.7%) patients had clinically mild PTE, 31 (34.8%) had submassive PTE, and 6 (6.7%) had massive PTE. IDT on V1, V2, and aVR of 12-lead electrocardiogram (ECG) were compared between those with and without PTE and between PTE severity groups. IDT on ECG was correlated with clinical, echocardiographic, and biochemical parameters. Results: Compared to PTE-negative subjects, IDT on lead V2 of ECG was significantly prolonged in PTE-positive patients, angiographically massive and non-massive PTE groups, and clinically massive and submassive groups. On correlation analyses, IDT on lead V2 was significantly correlated with the presence of PTE, angiographic and clinical severity, right ventricular systolic function, and right bundle branch block. Conclusion: Prolonged IDT on lead V2 is indicative of the presence of PTE, right ventricular dysfunction, and massive and submassive PTE. This parameter should be further studied in future large-scale prospective studies.

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