Sefa UNAL, Samet YILMAZ, Çağrı YAYLA, Mevlut Serdar KUYUMCU, Ilke ERBAY, Burak AÇAR, Mustafa KARANFİL, Ahmet Göktuğ ERTEM, Koray DEMIRTAS, Ahmet AKDI, Sinan AYDOĞDU

Akut miyokarditte fragmante QRS kompleksinin prognostik rolü

Amaç: Miyokarditin fulminan seyrini tahmin etmek zor olsa da, akut kalp yetmezliği ve ölüme neden olabilir. Önceki çalışmalar, sol ventrikül sistolik fonksiyonunun azaldığını ve uzamış QRS süresinin fulminan seyrini öngörebileceğini göstermiştir. Bu çalışma, fragmante QRS kompleksinin (fQRS) de bu popülasyondaki fulminan hastalığın öngörüsü olup olmadığını belirlemeyi amaçlamıştır.Gereç ve Yöntemler: Akut miyokardit tanısı almış 156 hastayı retrospektif olarak dahil ettik. Hastalar fulminan (n = 18) ve fulminan olmayan gruba (n = 138) ayrıldı. Fulminan hastalığı öngören bağımsız faktörleri tanımlamak için çok değişkenli lojistik regresyon analizi kullanılmıştır.Bulgular: Fragmante QRS fulminan grupta 11 (% 61), fulminan olmayan grupta sadece 10 hasta (% 7) gelişti (p <0.001). Fulminan miyokardit hastaları fulminan olmayan hastalardan daha yüksek mortalite oranına sahipti (% 44.6 vs.% 0, p <0.001). Çok değişkenli analiz, fQRS (p = 0.019), daha uzun Tp-e / QT oranının (p = 0.022) ve klinik kalp yetmezliğinin (<0.001) varlığında, fulminan bir miyokardit seyri ile ilişkili önemli belirleyiciler olduğunu ortaya koydu. Sonuç: Basit ve uygulanabilir bir elektrokardiyografik belirteç olarak fQRS kompleksinin varlığı, fulminan miyokarditin yeni bir belirleyicisi olarak görünmektedir. Bu basit parametre, uygunluk riski yüksek olan hastaları belirlemek için kullanılabilir ve bu nedenle erken mekanik destek daha iyi hasta sonuçları sağlayabilir.

Anahtar Kelimeler:

Akut Miyokardit, Fragmante QRS, Tp-e / QT oranı, Kalp yetersizliği

The prognostic role of fragmented QRS complex in acute myocarditis

Aim: Although a fulminant course of the myocarditis is difficult to predict, it may lead to acute heart failure and death. Previous studies have demonstrated that reduced left ventricular systolic function and prolonged QRS duration can predict the fulminant course. This study aimed to identify whether fragmented QRS complex (fQRS) could also be predictive of fulminant disease in this population. Material and Methods: We retrospectively included 156 patients diagnosed with acute myocarditis. They were divided into the fulminant group (n = 18) and the non-fulminant group (n = 138). Multivariate logistic regression analysis was used to identify the independent factors predictive of fulminant disease. Results: Fragmented QRS developed in 11 (61%) in the fulminant group and only 10 patients (7%) in the non-fulminant group (p <0.001). Patients with fulminant myocarditis had a higher mortality rate than those with non-fulminant disease (44.6% vs. 0%, p < 0.001). Multivariate analysis revealed that the presence of fQRS (p=0.019), longer Tpe/qt ratio (p=0.022) and clinical heart failure (<0.001) were significant predictors associated with a fulminant course of myocarditis. Conclusion: The presence of fQRS complex, as a simple and feasible electrocardiographic marker, seems to be a novel predictor fulminant myocarditis. This simpleparameter may be used in identifying patients at high risk for fulminancy and so early mechanical support could provide improved patient outcomes.

Keywords:

Myocarditis, Fragmented QRS, Tp-e/QT ratio, Heart Failure,

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