İsmail GÜRBAK, Arda GÜLER, Cafer PANÇ, Ahmet GÜNER, Mehmet ERTURK

Farklı Sol Ventriküler Geometrik Paterne Sahip Hipertansif Hastalarda Frontal QRS-T Açısının Değerlendirlmesi

Amaç: Hipertansif kalp hastalığının değerlendirilmesinde Sol ventrikül (SV) yapısının ve fonksiyonunun incelenmesi, kardiyovasküler morbidite ve mortalite hakkında önemli bilgiler sağlar.Frontal QRS-T açısı (fQRSTa), miyokardiyal depolarizasyon ve repolarizasyon arasındaki heterojenliği ölçmek için kullanılan yeni bir yöntemdir. Bu çalışmanın temel amacı, hipertansiyonlu (HT) hastalarda farklı SV geometrik paternleri ile fQRSTa arasındaki ilişkiyi incelemektir. Gereç ve Yöntemler: Kardiyoloji polikliniğine başvuran ardışık 273 hipertansiyon hastası çalışmaya dahil edildi. Tüm hastalar transtorasik ekokardiyografi ile değerlendirildi ve SV geometrik yapısına göre normal geometri (grup 0), konsantrik yeniden şekillenme (grup 1) ve konsantrik veya eksantrik hipertrofi (grup 2) olarak üç gruba ayrıldı. FQRSTa, frontol düzlem QRS aksı ile T dalga aksı arasındaki mutlak açı farkı olarak tanımlandı. Bulgular: FQRSTa'sı grup 0 ile karşılaştırıldığında, grup 1'de (12 [6 - 19] - 17 [12 - 24], p = 0.023) ve grup 2'de (12 [6 - 19] - 39 [28 – 54], p

Anahtar Kelimeler:

Sol ventrikül geometrisi;, frontal QRS-T açısı, hipertansiyon

The Status of Frontal QRS-T Angle in Hypertensive Patients with Different Left Ventricular Geometry

Objective: Assessing left ventricular (LV) structure and function gives information on cardiovascular morbidity and mortality, making it important for evaluating hypertensive heart disease. Frontal QRS-T angle (fQRSTa) is a novel approach to quantify the heterogeneity between myocardial depolarization and repolarization. The main purpose here was to define the correlation between different LV geometric patterns and fQRSTa in patients with hypertension (HT). Materials and Methods: 273 patients with hypertension who admitted to the cardiology out-patient clinic were enrolled consecutively. All patients were evaluated by transthoracic echocardiography and classified into three groups based on LV hypertensive geometry as normal geometry (group 0), concentric remodeling (group 1), and concentric or eccentric hypertrophy (group 2). The fQRSTa was defined as the absolute angle difference between frontal plane QRS axis and T wave axis. Results: Compared with group 0, fQRSTa was higher in group 1 (12 [6 – 19] vs. 17 [12 – 24], p=0.023) and group 2 (12 [6 – 19] vs. 39 [28 – 54], p

Keywords:

: Left ventricular geometry, frontal QRS-T angle, hypertension,

PDF

___

1.Ganau A, Devereux RB, Roman MJ, De Simone G, Pickering TG, Saba PS, et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol 1992; 19:1550-1558.
2.Kannel WB, Gordon T, Offutt D. Left ventricular hypertrophy by electrocardiogram. Prevalence, incidence, and mortality in the Framingham Study. Ann Intern Med 1969; 71:89-105.
3.Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 1990; 322:1561-1566.
4.González A, Ravassa S, López B, Moreno MU, Beaumont J, San José G, et al. Myocardial Remodeling in Hypertension. Hypertension. 2018;72(3):549-558.
5.Shenasa M, Shenasa H. Hypertension, left ventricular hypertrophy, and sudden cardiac death. Int J Cardiol. 2017; 237:60-63.
6. Clarkson PBM, Naas AAO, Mcmahon A, MacLeod C, Struthers AD, MacDonald TM. QT dispersion in essential hypertension. QJM Int. J Med. 1995;88(5):327-332.
7.Mozos I, Serban C. The relation between QT interval and T-wave variables in hypertensive patients. J Pharm Bioallied Sci. 2011;3(3):339-344.
8.Zhang Z, Rautaharju PM, Prineas RJ, Tereshchenko L, Soliman EZ. Electrocardiographic QRS-T angle and the risk of incident silent myocardial infarction in the Atherosclerosis Risk in Communities study. J Electrocardiol. 2017;50(5):661-666.
9.Keung ECH, Aronson RS. Non-uniform electrophysiological properties and electrotonic interaction in hypertrophied rat myocardium. Circ Res 1981; 49:150-158.
10.Güner A, Kalçık M, Çelik M, Uzun F, Çizgici AY, Ağuş HZ, et al. Impaired repolarization parameters may predict fatal ventricular arrhythmias in patients with hypertrophic cardiomyopathy (from the CILICIA Registry). J Electrocardiol 2020; 63:83-90.
11. Uzun F, Güner A, Demir AR, Can A, Yalçin AA, Aguş HZ, et al. Improvement of the frontal QRS-T angle after successful percutaneous coronary revascularization in patients with chronic total occlusion. Coron Artery Dis. 2020; 31:716-721.
12. Medvedovsky AT, Pollak A, Shuvy M, Gotsman I. Prognostic significance of the frontal QRS-T angle in patients with AL cardiac amyloidosis. J Electrocardiol. 2020; 59:122-125.
13.Lazzeroni D, Bini M, Camaiora U, Castiglioni P, Moderato L, Ugolotti PT, et al. Prognostic value of frontal QRS-T angle in patients undergoing myocardial revascularization or cardiac valve surgery. J Electrocardiol 2018; 51:967-972.
14.Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens 2018; 36:1953–2041
15.Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)developed with the special contribution of the heart failure association (HFA) of the ESC. Eur Heart J 2016; 37:2129–2200.
16.Panicker GK, Karnad DR, Natekar M, Kothari S, Narula D, Lokhandwala Y. Intra- and interreader variability in QT interval measurement by tangent and threshold methods in a central electrocardiogram laboratory. J Electrocardiol 2009; 42:348-52.
17.Oehler A, Feldman T, Henrikson CA, Tereshchenko LG. QRS-T angle: a review, Ann Noninvasive Electrocardiol 2014;19:534-42.
18.Salvi V, Clark E, Karnad DR, Macfarlane PW, Panicker GK, Hingorani P, et al. Comparison of the spatial QRS-T angle derived from digital ECGs recorded using conventional electrode placement with that derived from Mason-Likar electrode position. J Electrocardiol 2016; 49:714-9.
19.Brown RA, Schlegel TT. Diagnostic utility of the spatial versus individual planar QRS-T angles in cardiac disease detection. J Electrocardiol 2011; 44:404-9.
20.Borleffs CJ, Scherptong RW, Man SC, Van Welsenes GH, Bax JJ, van Erven L, et al. Predicting ventricular arrhythmias in patients with ischemic heart disease: clinical application of the ECG derived QRS-T angle. Circ Arrhythm Electrophysiol 2009; 2:548-54.
21.Pavri BB, Hillis MB, Subacius H, Brumberg GE, Schaechter A, Levine JH, et al. Prognostic value and temporal behavior of the planar QRS-T angle in patients with nonischemic cardiomyopathy.Defibrillators in Nonischemic Cardiomyopathy Treatment Evaluation (DEFINITE) Investigators.Circulation 2008; 117:3181-6.
22.Zhang X, Zhu Q, Zhu L, Jiang H, Xie J, Huang W. et al. Spatial/Frontal QRS-T Angle Predicts All-Cause Mortality and Cardiac Mortality: A Meta-Analysis. PloS One. 2015;10(8): e0136174.
23.Gotsman I, Shauer A, Elizur Y, Zwas DR, Lotan C, Keren A. Temporal changes in electrocardiographic frontal QRS-T angle and survival in patients with heart failure. PloS One. 2018;13(3): e0194520.
24.Lown MT, Munyombwe T, Harrison W, West RM, Hall CA, Morrell C. et al. Association of frontal QRS-T angle--age risk score on admission electrocardiogram with mortality in patients admitted with an acute coronary syndrome. Am J Cardiol. 2012;109(3):307-313.
25.Colluoglu T, Tanriverdi Z, Unal B, Ozcan EE, Dursun H, Kaya D. The role of baseline and post-procedural frontal plane QRS-T angles for cardiac risk assessment in patients with acute STEMI. Ann Noninvasive Electrocardiol Off J Int Soc Holter Noninvasive Electrocardiol Inc. 2018;23(5):e12558.
26. Aro AL, Huikuri HV, Tikkanen JT, Junttila MJ, Rissanen HA, Reunanen A. et al. QRS-T angle as a predictor of sudden cardiac death in a middle-aged general population. Europace 2012; 14(6):872-6.
27.Lavie CJ, Patel DA, Milani RV, et al. Impact of echocardiographic left ventricular geometry on clinical prognosis. Prog Cardiovasc Dis. 2014;57(1):3-9.
28.Paoletti E, De Nicola L, Gabbai FB, Chiodini P, Ravera M, Pieracci L. et al. Associations of Left Ventricular Hypertrophy and Geometry with Adverse Outcomes in Patients with CKD and Hypertension. Clin J Am Soc Nephrol CJASN. 2016;11(2):271-279. doi:10.2215/CJN.06980615
29.Park SK, Jung JY, Kang JG, Chung PW, Oh CM. Left ventricular geometry and risk of incident hypertension. Heart Br Card Soc. 2019;105(18):1402-1407.
30.Saba MM, Arain SA, Lavie CJ, Abi-Samra FM, Ibrahim SS, Ventura HO. et al. Relation between left ventricular geometry and transmural dispersion of repolarization. Am J Cardiol. 2005;96(7):952-955.
31.Malmqvist K, Kahan T, Edner M, Bergfeldt L. Cardiac repolarization and its relation to ventricular geometry and rate in reverse remodelling during antihypertensive therapy with irbesartan or atenolol: results from the SILVHIA study. J Hum Hypertens. 2007;21(12):956-965.