Ümit Ali MALÇOK, Mustafa ÇAM, Ercan AKŞİT, Özgül OCAK

Spontan İntraserebral Hemoraji ile fQRS Kompleksi Arasındaki İlişki

Amaç: Spontan intraserebral hemoraji (SİSH) insidansında, son üç dekat boyunca değişim olmadığı ve olguların yaş ortalamalarının arttığı görülmektedir. Günümüzde, hastaların tedavilerindeki başarı oranı artmakta ancak kanamaların tahmin edilmesinde umut verici bir ilerleme sağlanamamıştır. Bu çalışmada, fragmente QRS (fQRS) kompleks varlığı ile SİSH arasında bir ilişki olup olmadığını göstermeyi amaçladık.Materyal ve Metot: Bu çalışma vaka-kontrol çalışması olarak planlanmıştır. Çalışma kriterlere uygun 30 SİSH’li ve 30 sağlıklı kontrol bireye ait veriler kullanıldı. Hemoraji derecelendirme ölçeğine göre 1-5 puan alanlar çalışma dışı bırakıldı ve sıfır puan alan olgular çalışmaya alındı. Tüm olgulara ait elektrokardiyogram (EKG) kayıtlarının yorumlanması ve ekokardiyografi (EKO) işlemleri, kardiyoloji uzmanı tarafından kör olarak gerçekleştirildi ve EKG kayıtlarında fQRS kompleksi varlığı arandı.Bulgular: Hemoraji geçiren hastaların yaş ortalaması 69 ve 19’u (%63) erkekti. Grupların yaşları, diyabet prevalansı ve sigara alışkanlıkları arasında belirgin bir fark yoktu, ancak hipertansiyonun (HT) kanama geçiren olgularda daha fazla bulunduğu görüldü (p<0,05). Ayrıca SİSH hastalarında, kontrol grubuna kıyasla fQRS kompleksi daha sık görüldü (p<0,01). SİSH olgularına ait EKO parametrelerinde ise sol ventrikül ejeksiyon farksiyonunda (SVEF) azalmanın (p<0,05) yanı sıra sol atriyumda (SA) artış olduğu görüldü (p<0,05). Bununla birlikte, EKG kayıtlarında fQRS kompleksi bulunan SİSH olgularının, kontrol grubuna göre 5 kat daha fazla olduğu görüldü (OR 5,2, p<0,01).Sonuç: Bu çalışmada fQRS varlığı ile SİSH arasındaki ilişki değerlendirildi. EKG’sinde fQRS kompleksi bulunan; SVEF’de azalma, SA’da artma olan ve eşlik eden HT’si olan hastalarda, SİSH’nin daha fazla görüldüğü sonucuna ulaşıldı.

Anahtar Kelimeler:

fragmente QRS, spontan intraserebral hemoraji, elektrokardiyogram

RELATION BETWEEN SPONTANEOUS INTRACEREBRAL HEMORRHAGE AND fQRS COMPLEX

Introduction: There has not been a change in spontaneous intracerebral hemorrhage (SICH) incidence over the last three decades. Mean age of cases keep rising. Despite the rising success rate of treatments, there has not been a significant improvement in prediction of hemorrhages beforehand. In this study, we aimed to find whether there was a relation between fragmented QRS (fQRS) complex and SICH in follow-up of risky patients.Materials and Methods: This study was planned as a case-control study. The data of 30 SISH and 30 healthy control individuals who meet the criteria were used in the study. Those who scored between 1-5 points according to the hemorrhage severity scale were discarded and the cases who scored zero points were included in the study. Interpretation of electrocardiogram (ECG) records and echocardiogram (ECHO) procedures were performed blindly by a cardiologist. The existence of fQRS complex in ECG records and standard parameters in ECHO procedure were evaluated.Results: Mean age of hemorrhage cases was 69 and 19 of them (%63) were male. There were not any significant differences in age, diabetes prevalance and smoking habits between groups, however, hypertension (HT) was seen more frequently in hemorrhage cases (p<0.05). fQRS complexes were seen more frequently in SICH group compared to the control group (p<0.01). In addition to the decrease in left ventricular ejection fraction (LVEF) (p<0.05), there was also an increase in left atrium (LA) (p<0.05). However, it was observed that SISH cases with fQRS complex in ECG recordings were 5 times more than the control group (OR 5.2, p<0.01).Conclusion: In this study, the relation between the existence of fQRS and SICH risk was evaluated. The fQRS complex in his ECG; It was concluded that in patients with a decrease in LVEF, an increase in LA and accompanying HT, SISH is seen more.

Keywords:

fragmented QRS, spontaneous intracerebral hemorrhage, electrocardiogram,

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1. Morotti A, Goldstein JN. Diagnosis and Management of Acute Intracerebral Hemorrhage. Emerg Med Clin North Am. 2016;34(4):883-99. https://doi.org/10.1016/j.emc.2016.06.010
2. Ikram MA, Wieberdink RG, Koudstaal PJ. International epidemiology of intracerebral hemorrhage. Curr Atheroscler Rep. 2012;14(4):300-6. https://dx.doi.org/10.1007/s11883-012-0252-1
3. Jolink WMT, Wiegertjes K, Rinkel GJE, et al. Location-specific risk factors for intracerebral hemorrhage: Systematic review and meta- analysis. Neurology. 2020:29;95(13):e1807-8. https://dx.doi.org/10.1212/WNL.000000000001 0418
4. Koppikar S, Baranchuk A, Guzmán JC, et al. Stroke and ventricular arrhythmias. Int J Cardiol. 2013;168(2):653-9. https://dx.doi.org/10.1016/j.ijcard.2013.03.058
5. Ruthirago D, Julayanont P, Tantrachoti P, et al. Cardiac Arrhythmias and Abnormal Electrocardiograms After Acute Stroke. Am J Med Sci. 2016;351(1):112-8. https://dx.doi.org/10.1016/j.amjms.2015.10.020
6. Das MK, Khan B, Jacob S, et al. Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease. Circulation. 2006;113(21):2495-501. https://dx.doi.org/10.1161/CIRCULATIONAH A.105.595892
7. Adar A, Kırış A, Bülbül Y, et al. Association of Fragmented QRS with Subclinical Left Ventricular Dysfunction in Patients with Obstructive Sleep Apnea. Med Princ Pract. 2015;24(4):376-81. https://dx.doi.org/10.1159/000382077
8. Baş Y, Altunkaş F, Seçkin HY, et al. Frequency of fragmented QRS in patient with psoriasis vulgaris without cardiovascular disease. Arch Dermatol Res. 2016;308(5):367-71. https://dx.doi.org/10.1007/s00403-016-1653-8
9. Hemphill JC, BonovSICH DC, Besmertis L, et al. The SICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001;32(4):891-7. https://dx.doi.org/10.1161/01.str.32.4.891
10. Galderisi M, Cosyns B, Edvardsen T, et al. Standardization of adult transthoracic echocardiography reporting in agreement with recent chamber quantification, diastolic function, and heart valve disease recommendations: an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2017;18(12):1301- 10. https://dx.doi.org/10.1093/ehjci/jex244.%20PM ID:%2029045589
11. van Asch CJ, Luitse MJ, Rinkel GJ, et al. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol. 2010;9(2):167-76. https://dx.doi.org/10.1016/S1474- 4422(09)70340-0
12. Takeuchi S, Takasato Y, Masaoka H, et al. Simultaneous multiple hypertensive intracranial hemorrhages. J Clin Neurosci. 2011;18(9):1215- 8. https://dx.doi.org/10.1016/j.jocn.2011.01.020
13. Persic V, Ruzic A, Miletic B, et al. Left ventricle diastolic dysfunction in obese patients with newly diagnosed arterial hypertension. Wien Klin Wochenschr. 2007;119(13-14):423-7. https://dx.doi.org/10.1007/s00508-007-0818-z
14. Amin OSM, Al-Bajalan SJ, Mubarak A. QTc Interval Prolongation and Hemorrhagic Stroke: Any Difference Between Acute Spontaneous Intracerebral Hemorrhage and Acute Non- traumatic Subarachnoid Hemorrhage? Med Arch. 2017;71(3):193-7. https://dx.doi.org/10.5455/medarh.2017.71.193- 197
15. Take Y, Morita H. Fragmented QRS: What Is The Meaning? Indian Pacing Electrophysiol J. 2012;12(5):213-25. https://dx.doi.org/10.1016/s0972- 6292(16)30544-7