Çağdaş AKGÜLLÜ, Ufuk ERYILMAZ, Evrin DAĞTEKİN, Mehmet AKDENİZ, Hasan GÜNGÖR, Cemil ZENCİR, İmran KURT ÖMÜRLÜ

Akut Pulmoner Embolili Hastalarda Erken Olumu Ongormede P Dalgası ve QT Dispersiyonlarinin Faydasi

AMAÇ: Akut pulmoner emboli varlığında P dalgası ve QT dispersiyonlarının erken ölüm ile ilişkisini sorgulamak ve birbiriyle kıyaslamak istedik.GEREÇ VE YÖNTEMLER: Mayıs 2012 ve Haziran 2013 tarihleri arasındaki 124 hastanın arşiv verileri retrospektif olarak analiz edildi. Bunların içinden sinüs ritminde olan ve verileri QT ve P dalga analizlerine uygun olanlar çalışmaya dahil edildi. Her bir hasta için düzeltilmiş QT intervali ve P dalga dispersiyon analizleri yapıldı. BULGULAR: Çalışma grubundaki 12 hasta (%13) ölürken 81 hasta (%87) akut pulmoner emboli tanısı sonrası yaşadı. Ölülerin P dalga dispersiyonu değerleri yaşayanlardan anlamlı olarak daha yüksek saptandı (sırası ile 59.2±21.2 msn’e kıyasla 44.8±13.5 msn, p=0.04). Ayrıca, ölülerin düzeltilmiş QT dsipersiyonu değerleri de yaşayanlardan anlamlı olarak daha yüksek saptandı (sırasıyla 105.5 msn ve 80 msn , p<0.001). P dalga dispersiyonunun >64.5 msn için erken ölümü öngörme sensitivitesi %58,3, spesifitesi %97,5 (p=0.017) olarak bulunurken, düzeltilmiş QT dispersiyonunun >97 msn için erken ölümü öngörme sensitivitesi %83,3, spesifitesi %82,7 olarak bulundu (p<0.001).SONUÇ: Her iki elektrokardiyografi parametresi P dalga dispersiyonu ve QT dispersiyonu iyi ve yararlı markerlar olarak görünmektedir. Bu çalışmada, akut pulmoner emboli seyrinde daha yüksek riskli hastaları ve daha yoğun medikal tedaviye ihtiyacı olanları saptamada, düzeltilmiş QT dispersiyonunun P dalga dispersiyonuna kıyasla daha değerli olduğunu gösterdik

Anahtar Kelimeler:

Erken olum, P dalga dispersiyonu, prediktör, pulmoner emboli, QT dispersiyonu

Usefullness of P-wave and QT Dispersions for Predicting Early Death in Patients with Acute Pulmonary Embolism

OBJECTIVE: We aimed to demonstrate and compare to each other the relations of QT and P wave dispersions with early death in the course of acute pulmonary embolism (PE). MATERIALS AND METHODS: The archive data of 124 patients who had been hospitalized in our hospital with the diagnosis of acute PE between May 2012 and June 2013 was retrospectively reviewed. 93 patients who were in sinus rhythm and whose data were suitable for QT interval and P wave analyses were included to the study. Analyses of corrected QT interval dispersion (QTcd) and P wave dispersion (Pd) were performed for each patients. RESULTS: Among the study population, 12 patients (13%) died and 81 patients (87%) lived after the diagnosis of PE. PD values of deaths were significantly higher than those who survived (59.2±21.2 msec versus 44.8±13.5 msec respectively, p=0.04). Moreover, QTcd values of deaths were also significantly higher than the survivors (105.5 msec (99-119) versus 80msec (74-88) respectively, p<0.001). The sensitivity of Pd>64.5 msec for prediction of early mortality was found to be 58.3% with a specificity of 97.5% (p=0.017) where the sensitivity of Qtcd> 97 msec for prediction of early mortality was found to be 83.3% with a specificity of 82.7% (p<0.001). CONCLUSION: Both electrocardiography parameters Pd and QTcd may be used as a good and useful markers. We found that, in comparison to Pd, QTcd is superior to detect those who were under potential high risk and who need more aggressive treatment in the course of acute PE.

Keywords:

Early death, P wave dispersion, predictor, pulmonary embolism, QT interval dispersion,

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