Hakan SAKALLI, Didem Arslan TAS, Osman KARAARSLAN, Huseyin MERTSOYLU, Bahattin YILMAZ, Abdullah CANATAROGLU

Doksorubisin Kardiyotoksisitesinin Sinyal Ortalamali Elektrokardiyografi İle Değerlendirilmesi

AMAÇ: Sinyal ortalamalı elektrokardiyografi miyokardiyal hasarla oldukça ilişkili olan geç potansiyeller olarak adlandırlan düşük amplitüdlü sinyalleri saptar. Bu çalışmadaki amacımız, doksorubisinin miyokardiyal yan etkileri ile sinyal ortalamalı elektrokardiyogram arasındaki potansiyel ilişkiyi araştırmaktır. YÖNTEM: Doksorubisin içeren kemoterapi alan 48 hasta çalışmaya dahil edildi. Sinyal ortalamalı elektrokardiyografi, 3 parametre kullanılarak ölçüldü: filtrelenmiş QRS (fQRS), fQRS süresinin son 40 milisaniyesi boyunca saptanan voltajın karekökü (RMS40), fQRS in son 40 milisaniyesinden başlayarak 40μV altına düştükten sonraki geçen süre (HFLA40). Hastaların ejeksiyon fraksiyonları, ekokardiyografi ile ölçüldü. SONUÇLAR: Ortalama yaş 44 (27-70) yıl idi. Ortalama kümülatif doksorubisin dozu 475.56±98.45 mg idi. Ölçülen sinyal ortalamalı elektrokardiyografik parametrelerin ortalama süreleri şöyleydi: fQRS:78.27±10.74 milisaniye, RMS40: 115.10±50.23 ve HFLA: 21.95±8.39 mikrovolt idi. Doksorubisin dozu ile fQRS arasında pozitif korelasyon saptanırken (r=0.28, p=0.02), RMS40 arasında negatif korelasyon mevcuttu (r=-.31,p=0.03). Doksorubisin dozu ile ejeksiyon fraksiyonları arasında korelasyon saptanmadı (r=.18, p=0.22). TARTIŞMA: Bulgularımız, kümülatif doksorubisin dozları ile fQRS ve RMS40 arasında anlamlı korelasyon olduğunu düşündürmektedir. Bu yüzden sinyal ortalamalı elektrokardiyografik parametreler doksorubisin içeren tedaviler alan hastalarının prognozunu belirlemede değerli olabilir.

Anahtar Kelimeler:

Sinyal ortalamalı elektrokardiyografi, doksorubisin, kardiyotoksisite

Evaluation of Doxorubicin Cardiomyopathy by Signal Averaged Electrocardiography

BACKGROUND: Signal-averaged electrocardiography detects low-amplitude signals designated as late potentials which are strongly related to myocardial damage. We aimed to search for the possible relation between the myocardial effects of doxorubicin and signal-averaged electrocardiographic parameters. METHODS: Fortyeight patients who received doxorubicin included chemotherapy were enrolled. Signal-averaged electrocardiographic parameters were detected by using 3 parameters; filtered QRS (fQRS), the square root of the voltage obtained during the last 40 milliseconds of the duration of fQRS (RMS40), the duration starting from the last 40 miliseconds of fQRS till the decrease of voltage under 40 microvolts. (HFLA40). Ejection fractions of the patients were measured by echocardiographic evaluation. RESULTS: Median age was 44 (27-70) years. Mean cumulative doxorubicin dosage was 475.56±98.45 mg. Mean values of the measured signal-averaged electrocardiographic parameters were as follows; fQRS: 78.27±10.74 miliseconds, RMS40:115.10±50.23 and HFLA was 21.95±8.39 microvolts . The doses of doxorubicin showed a positive correlation with fQRS (r=0.28, p=0.02) and a negative correlation with RMS40 (r=-.31,p=0.03). There was no correlation between the doxorubicin dosage and the ejection fraction of the patients (r=.18, p=0.22). CONCLUSION: Our results suggested that significant correlations are present between fQRS and RMS40 and cumulative doxorubicin dosages. Therefore, signal-averaged electrocardiographic parameters may be of value for predicting the prognosis of the patients who have received doxorubicin included chemotherapy.

Keywords:

Signal-averaged electrocardiography, doxorubicin, cardiotoxicity,

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Yazışma Adresi / Address for Correspondence: Dr. Didem Arslan Taş Adana Numune Training and Research Hospital İnternal Medicine and Rheumatology Department ADANA e-mail: arslan_didem@yahoo.com Tel: 00 90 554 7547364 Fax: 00 90 322 3386373 geliş tarihi/received :09.08.2012 kabul tarihi/accepted:05.10.2012 .