Cüneyt KOCAŞ, Çağlar ÇUHADAROĞLU, Fatih UZUN, Ahmet Arif YALÇIN, Faruk AKTÜRK, Ayfer Utku SAVAŞ, Firuzan Pınar KUZER, İsmail BIYIK, Aydın YILDIRIM, Nevzat USLU, Mehmet ERTÜRK

Günlük klinik uygulamada kronik obstrüktif akciğer hastalığının şiddetinin değerlendirilmesinde elektrokardiyografinin rolü

Giriş: Kronik obstrüktif akciğer hastalığı (KOAH) kronik morbidite ve mortalitenin dördüncü önde gelen nedenidir. Bron- şiyal obstrüksiyon ve artmış pulmoner vasküler direnç sağ atriyal fonksiyonları bozmaktadır. Bu çalışmada, KOAH hasta- larında bronşiyal obstrüksiyonun p dalga aksı üzerine olan etkisini ve KOAH şiddetini değerlendirmede elektrokardiyog- rafi (EKG)’nin yararlılığını araştırmayı amaçladık. Hastalar ve Metod: Doksan beş hasta (64’ü erkek, 31’i kadın) çalışmaya dahil edildi. Hastalar sinüs ritminde, normal ejek- siyon fraksiyonuna ve normal kalp boşluk boyutlarına sahipti. Hastaların solunum fonksiyon testleri ve 12 derivasyonlu elektrokardiyogramları aynı gün elde edildi. KOAH şiddeti ile p dalga aksı, p dalga süresi, QRS aksı ve QRS süresini içe- ren EKG bulguları arasındaki ilişkiler araştırıldı. Bulgular: Ortalama yaş 58 ± 12 yıl idi. Ortalama p dalga aksı 62 ± 18 derece idi. Bu çalışmada, p dalga aksı, KOAH evre- leri ve QRS aksı ile anlamlı pozitif korelasyonlar, fakat FEV1, FEF, BMI ve QRS süresi arasında anlamlı negatif korelasyon- lar ortaya koydu. KOAH evreleri arttıkça p dalga aksı artmaktadır. Sonuç: Frontal p dalga aksının vertikalizasyonu, p pulmonale gibi sağ kalp boşluklarının genişlemesi ve hipertrofisinin di- ğer EKG değişikliklerinin oluşmasından önce KOAH’ın kötüleşmesinin erken bir bulgusu olabilir. Sağ atriyal elektriksel ak- tiviteyi ve sağ kalp yüklenmesini yansıtan frontal p dalga aksının vertikalizasyonu hızlı hasta bakılan poliklinik ortamın- da KOAH şiddetinin çabuk bir şekilde değerlendirilmesinde yararlı bir parametre olabilir.

The role of electrocardiography in evaluation of severity of chronic obstructive pulmonary disease in daily clinical practice

ntroduction: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of chronic morbidity and morta- lity. Bronchial obstruction and increased pulmonary vascular resistance impairs right atrial functions. In this study, we ai- med to investigate the effect of bronchial obstruction on p wave axis in patients with COPD and usefulness of electrocardi- ography (ECG) in the evaluation of the severity of COPD. Patients and Methods: Ninety five patients (64 male and 31 female) included to the study. Patients were in sinus rhythm, with normal ejection fraction and heart chamber sizes. Their respiratory function tests and 12 lead electrocardiograms we- re obtained at same day. Correlations with severity of COPD and ECG findings including p wave axis, p wave duration, QRS axis, QRS duration were studied. Results: The mean age was 58 ± 12 years. Their mean p wave axis was 62 ± 18 degrees. In this study, p wave axis has de- monstrated significant positive correlations with stages of COPD and QRS axis but significant negative correlations with FEV1, FEF, BMI and QRS duration. P wave axis increases with increasing stages of COPD. Conclusion: Verticalization of the frontal p wave axis may be an early finding of worsening of COPD before occurrences of other ECG changes of hypertrophy and enlargement of right heart chambers such as p pulmonale. Verticalization of the frontal p wave axis reflecting right atrial electrical activity and right heart strain may be a useful parameter for quick esti- mation of the severity of COPD in an out-patient cared.

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