Hakan Taşolar, Mehmet Cansel, Jülide Yağmur, Ahmet Oğuz Baktır, Necip Ermiş, Nusret Açıkgöz, Yasin Karakuş, Adil BAYRAMOĞLU

Mitral Anulus Kalsifikasyonu Olan Hastalarda P Dalga ve QT Parametrelerinin Normal Bireylerle Karşılaştırılması

Amaç: Mitral anulus kalsifikasyonu, mitral kapağın fibröz iskeletinin kronik dejeneratif inflamatuvar olmayan kalsifikasyonudur. Biz çalışmamızda MAK'lı hastalarda atriyal ve ventriküler aritmi riski açısından P dalga ve QT parametrelerini incelemeyi amaçladık. Gereç ve Yöntem: Çalışmaya ekokardiyografik olarak MAK tanısı konan 42 hasta ve yaş ve cinsiyet olarak eşleştirilmiş 30 sağlıklı birey alındı. MAK olan hastalarda p dalga dispersiyonu (Pd), düzeltilmiş QT (QTc) ve QTc dispersiyonu (QTcd) bakıldı. Bulgular: En uzun p dalga süresi (Pmax) (110,7±80,3 karşı 72.0±20,1, p<0,05) ve Pd'u (63,8±83,4 karşı 27,3±20,7, p<0,005) hasta grubunda kontrol grubundan daha uzundu. QT aralığı, QTc aralığı, QT dispersiyonu (QTd) ve QTcd açısından hasta ve kontrol grubunda istatistiki olarak fark yoktu. Hasta ve kontrol grubunda koroner arter hastalığı risk faktörleri ile Pd arasında tek değişkenli varyans analizi yapıldığında; Pd fazlalığına diyabetes mellitus (p<0,005, testin gücü=0,894) ve koroner arter hastalığı mevcudiyetinin (p<0,0001, testin gücü=1,000) belirgin etkili olduğu gözlendi. Sol atriyum çapı hasta grubunda daha fazlaydı (4,4±0,7 karşı 3,7±0,6 p<0,001). Sol atriyum boyutuyla Pmax ve Pd arasında belirgin pozitif korelasyon saptandı. Sonuç: Artmış Pmax ve Pd parametreleri MAK olan hastalarda atriyal aritmi ve atriyal fibrilasyon (AF) sıklığındaki artışın bir ön belirteci olabilir. Anahtar kelimeler: Mitral Anulus Kalsifikasyonu; P Dalga Dispersiyonu; QT Dispersiyonu.

Anahtar Kelimeler:

Mitral Anulus Kalsifikasyonu; P Dalga Dispersiyonu; QT Dispersiyonu.

Comparison of P Wave and QT Parameters Between Patients with Mitral Annulus Calcification and Healthy Subjects

Objective: Mitral annular calcification (MAC) is the chronic, non inflammation and degenerative calcification of the supportive ring of mitral valve. In our study we aim to show that the risk of atrial and ventricular arrhythmias in patients with MAC and we investigated the P wave and QT parameters. Materials and Methods: We performed echocardiographic study in 42 patients were diagnosed with MAC and 30 healthy individuals. We evaluated P wave dispersion (Pwd), corrected QT (QTc) and corrected QT dispersion (QTcd) intervals in patients with MAC. Results: The longest P wave time (Pmax) (110.7±72.0±20.1 to 80.3, p<0.05) and Pwd (63.8±27.3±20.7 to 83.4, p<0.005) in patients group was longer than the control group. In terms of QT interval, QTc, QT dispersion (QTd) and QTcd patient and control groups did not differ statistically. when univariate analysis of variance was made between patient and control groups with coronary artery disease risk factors and Pd; it was found that presence of diabetes mellitus (p <0.005, test power = 0.894) and coronary artery disease (p<0.0001, test power = 1.000) were significantly effective on Pd excess. Left atrial diameter was higher in the patient group (4.4±3.7±0.6 to 0.7, p<0.001). Significantly positive correlation was found between left atrial size and the Pmax and Pwd. Conclusion: Increased Pmax and Pwd parameters in patients with MAC may be a preliminary indicator that increased atrial arrhythmia and incidence of atrial fibrillation (AF). Key words: Mitral Annulus Calcification; P Wave Dispersion; QT Dispersion.

Keywords:

Mitral Annulus Calcification; P Wave Dispersion; QT Dispersion.,

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Fox CS, Vasan RS, Parise H, et al. Mitral annular calcification predicts cardiovascular morbidity and mortality: the Framingham Heart Study. Circulation 2003;107:1492-6.
Adler Y, Vaturi M, Fink N, et al. Association between mitral annulus calcification and aortic atheroma: a prospective transesophageal echocardiographic study. Atherosclerosis. 2000;152(2):451-6.
Ross R. Atherosclerosis-An inflammatory disease. N Engl J Med 1999;340:115-126.
Demopoulos LA, Tunick PA, Bernstein NE, et al. Protruding atheromas of the aortic arch in symptomatic patients with carotid artery disease. Am Heart J 1995;129:40-4.
Savage DD, Garrison RJ, Castelli WP, et al. Prevalence of submitral (annular) calcium and its correlates in a general population-based sample (the Framingham study). Am J Cardiol 1983;51:1375-78.
Kanjanauthai S, Nasir K, Katz R, et al. Relationships of mitral annular calcification to cardiovascular risk factors: the Multi- Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2010;213(2):558-62. Epub 2010 Sep 16.
Nair CK, Runco V, Everson GT, et al. Conduction defects and mitral annulus calcification. Br Heart J 1980;44:162-7.
Tsikouris JP, Kluger J, Song J, et al. Changes in P-wave dispersion and P-wave duration after open heart surgery are associated with the peak incidence of atrial fibrillation. Heart Lung Nov-Dec; , 2001;30(6):466-71.
O’Hara GE, Brugada P, Rodriguez LM, et al. Incidence, pathophysiology and prognosis of exercise-induced sustained ventricular tachicardia associated with healed myocardial infarction. Am J Cardiol 1992;70:875.
Day CP, Mc Comb JM, Campbell RW. QT dispersion: An indication of arrhythmia risk in patients with long QT intervals. Br Heart J 1990;63:342.
Adler Y, Koren A, Fink N, et al. Association between mitral annulus calcification and carotid atherosclerotic disease. Stroke 1998;29:1833-37.
Adler Y, Fink N, Spector D, et al. Mitral annulus calcification- a window to diffuse atherosclerosis of the vascular system Atherosclerosis 2001;155: 1-8.
Pressman GS, Agarwal A, Braitman LE, et al. Mitral annular calcium causing mitral stenosis Am J Cardiol 2010;105(3):389-91.
Galante A, Pietroiusti A, Marina Velini M, et al. C-reactive protein is increased in patients with degenerative aortic valvular stenosis. J Am Coll Cardiol 2001;38:1078-82.
Pekdemir H, Cin V, G, Çamsarı A, et al. “Mitral Anulus Kalsifikasyonlu Hastalarda C-Reaktif Proteinin Rolü," İstanbul, Üniversitesi Kardiyoloji Enstitüsü Dergisi (2003):2(4):11-14
Chu H, Chen J, Guo R. The association between cardiac calcification and coronary artery disease. Acta Cardiol 2009;64(4):531-5.
Seo Y, Ishimitsu T, Ishizu T, et al. Relationship between mitral annular calcification and severity of carotid atherosclerosis in patients with symptomatic ischemic cerebrovascular disease. J Cardiol 2005;46(1):17-24.
Aronow WS, Ahn C, Kronzon I, et al. Association of mitral annular calcium with symptomatic peripheral arterial disease in older patients. Am J Cardiol 2001;88:333-4.
Kamensky G, Lisy L, Polak E, et al. Mitral annular calcifications and aortic plaques as predictors of increased cardiovascular mortality. J Cardiol 2001;37(Suppl 1):21-26.
Durāo D, Pitta Mda L, Alves M, et al. Myocardial infarction as the first probable manifestation of caseous calcification of the mitral annulus. Rev Port Cardiol 2009;28(11):1271-5.
Korn D, DeSanctis RW, Sell S. Massive calcification of the mitral annulus: a clinicopathological study of fourteen cases. N Engl J Med 1962; 267:200-9.
Fulkerson PK, Beaver BM, Auseon JC, et al. Calcification of the mitral annulus: etiology, clinical association, complications, and therapy. Am J Med 1979;66:967-77.
Takamoto T, Popp RL. Conduction disturbances related to the site and severity of mitral anular calcification: a 2-dimensional echocardiographic and electrocardiographic correlative study. Am J Cardiol 1983;51:1644-9.
Lenegre J Etiology and pathology of bilateral bundle branch block in relation to complete heart block. Prog Cardiovasc Dis 1964; 6:409-44
Scarpa WJ. The sick sinus syndrome. Am Heart J 1976; 92:648-60
Kannel WB, Wolf PA. Epidemiology of atrial fibrillation. P.81- 92. In RH Falk, PJ Podrid (ed): Atrial fibrillation. Mechanisms and management. New York, Raven Press Ltd, 1992.
Allessie MA, Bonke FIM, Schopman FJG. Circus movement in rabbit atrial muscle as a mechanism of tachycardia. The role of nonuniform recovery of excitability in the occurance of unidirectional block as studied with multiple electrodes. Circ Res 1976;39:168-77.
Kawano S, Hiraoka M, Sawanobori T. Electrocardiographic features of p waves from patients with transient atrial fibrillation. Jpn Heart J 1988;29:57-67.
Dilaveris PE. P-wave dispersion: a novel predictor of paroxysmal atrial fibrillation. Ann Noninvasive Electrocardiol 2001;6(2):159- 65.
Ozmen F, Atalar E, Aytemir K, et al. Effect of balloon-induced acute ischaemia on P wave dispersion during percutaneous transluminal coronary angioplasty. Europace 20013(4):299-303.
Cui QQ, Zhang W, Wang H, et al. Assessment of atrial electromechanical coupling and influential factors in nonrheumatic paroxysmal atrial fibrillation. Clin Cardiol 2008;31(2):74-8.
Pekdemir H, Cansel M, Yağmur J, et al. Assessment of atrial conduction time by tissue Doppler echocardiography and P-wave dispersion in patients with mitral annulus calcification. J Electrocardiol 2010 Jul;43(4):339-43. Epub 2010 Apr 8.
Zabel M, Portnoy S, Franz MR. Electrocardiographic indexes of dispersion of ventricular repolarisation: an isolated heart validation study. J Am Coll Cardiol 1995;25:746-52.
Hansen S, Rasmussen V, Torp-Pedersen C, et al. QT intervals and QT dispersion determined from a 12-lead 24-hour Holter recording in patients with coronary artery disease and patients with heart failure. Ann Noninvasive Electrocardiol 2008;13(1):22-30.
Guven B, Eroglu AG, Babaoglu K, et al. QT dispersion and diastolic functions in differential diagnosis of primary mitral valve prolapse and rheumatic mitral valve prolapse.Pediatr Cardiol 2008;29(2):352-8. Epub 2007 Oct 5.