Koroner arteriyel baskınlık ve QRS ekseni arasındaki ilişki

Amaç: Koroner arter baskınlığı, sol veya sağ koroner dolaşım tarafından perfüze edilen miyokardın miktarını ve anatomik konumunu etkiler. Ancak, koroner arter baskınlığı ile 12-lead yüzey elektrokardiyografisindeki (EKG) QRS ekseni arasındaki ilişki araştırılmamıştır. Bu çalışma, ciddi koroner arter ve yapısal kardiyak hastalığı olmayan hastalarda koroner arter baskınlığı ile yüzey EKG’ deki QRS ekseni arasındaki ilişkiyi değerlendirmeyi amaçlamaktadır.Gereç ve Yöntemler: Ciddi koroner arter hastalığı olmayan ve dahil etme kriterlerini karşılayan tam olarak 133 hasta bu çalışmaya katılmıştır. Tüm çalışma hastalarında standart yüzey 12-lead EKG çekildi. QT aralığı, QTc aralığı, QRS süresi, PR aralığı, P dalgası ve QRS ekseni belirlendi. Posterior inen koroner arterin kökenine göre koroner dolaşım, sağ, sol ve dengeli (kodominant) koroner dominant olarak sınıflandırıldı.Bulgular: 56 sağ dominant (% 42), 39 sol dominant (% 29) ve 38 kodominant (% 29) paternli 133 hasta vardı. Kodominant ve sağ dominant grup ile karşılaştırıldığında, QRS ekseni değeri sol dominant grupta anlamlı olarak daha yüksek bulundu (p˂0.05). Kodominant ve sağ dominant gruplar arasında QRS ekseni değerleri açısından anlamlı fark saptanmadı. Sol dominant grupta QRS ekseni (+30) - (+ 90) oranı, kodominant ve sağ dominant grup ile karşılaştırıldığında anlamlı derecede yüksek olduğu bulundu (p˂0.05). Kodominant ve sağ dominant gruplar arasında QRS ekseni (+30) - (+ 90) oranları arasında anlamlı bir fark gözlenmedi. Sonuç: Bulgularımız QRS ekseninin koroner arter baskınlığı ile ilişkili olabileceğini düşündürmektedir.

Anahtar Kelimeler:

Koroner arter baskınlığı, QRS ekseni

The relationship between coronary arterial dominance and the QRS axis

Aim: Coronary artery dominance influences the amount and anatomic location of myocardium that is perfused by the left or right coronary circulation. However, the association between coronary arterial dominance and the QRS axis on 12-lead surface electrocardiography (ECG) was not investigated. The present study aims to evaluate the relationship between coronary arterial dominance and the QRS axis on ECG in patients without significant coronary artery and structural cardiac disease.Material and Methods: Overall, 133 patients, without significant CAD and who met the inclusion criteria, participated in this study. A standard surface 12-lead ECGs were performed in all study patients. QT interval, QTc interval, QRS duration, PR interval, P wave and QRS axis were determined. Based on the origin of the posterior descending coronary artery, coronary circulation was categorised into left, right, and balanced coronary dominance.Results: There were 133 subjects with 56 right dominant (42%), 39 left dominant (29%) and 38 codominant (29%) pattern. QRS axis value was found to be significantly higher in the left dominant group when compared with the codominant and right dominant group (p˂0.05). No significant difference was observed between the codominant and right dominant groups regarding QRS axis values. The axis of (+30)-(+90) ratio in the left dominant group was found to be significantly higher when compared with the codominant and right dominant group (p˂0.05). No significant difference was observed between the codominant and right dominant groups regarding the axis of (+30)-(+90) ratio. Conclusion: Our findings suggested that the QRS axis may be related to coronary artery dominance

Keywords:

Coronary artery dominance, QRS axis,

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1. Allwork SP. The applied anatomy of the arterial blood supply to the heart in man. J Anat 1987; 153: 1–16.
2. Omerbasic E, Hasanovic A, Omerbasic A, Pandur S. Prognostic value of anatomical dominance of coronary circulation in patients with surgical myocardial revascularization. Med Arch 2015; 69: 6-9
3. Lam MK, Tandjung K, Sen H et al. Coronary artery dominance and the risk of adverse clinical events following percutaneous coronary intervention: insights from the prospective, randomised TWENTE trial. EuroIntervention 2015; 11: 180-87
4. Veltman CE, van der Hoeven BL, Hoogslag GE et al. Influence of coronary vessel dominance on short- and long-term outcome in patients after ST-segment elevation myocardial infarction. Eur Heart J 2015; 36: 1023-30
5. Gebhard C, Gick M, Ferenc M et al. Coronary dominance and prognosis in patients with chronic total occlusion treated with percutaneous coronary intervention. Catheter Cardiovasc Interv 2017; 91: 669-78
6. Surawicz B, Childers R, Deal BJ et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part III: intraventricular conduction disturbances: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol 2009; 53: 976-81
7. Spodick DH, Frisella M, Apiyassawat S. QRS axis validation in clinical electrocardiography. Am J Cardiol 2008; 101: 268-69.
8. Scanlon PJ, Faxon DP, Audet AM et al. (ACC/AHA guidelines for coronary angiography. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Coronary Angiography). Developed in collaboration with the Society for Cardiac Angiography and Interventions. J Am Coll Cardiol 1999; 33: 1756–824.
9. Kashou AH, Kashou HE. Electrical Axis (Normal, Right Axis Deviation, and Left Axis Deviation). StatPearls. Treasure Island (FL): StatPearls Publishing; 2018 Jan-2017 Dec 12.
10.Bobba P, Salerno JA, Casari A. Transient left posterior hemiblock--report of four cases induced by exercise test. Circulation 1972; 46: 931-38.
11. Hegge FN, Tuma N, Burchell HB. Coronary arteriographic findings in patients with axis shifts or S-T-segment elevations on exercise-stress testing. Am Heart J 1973; Nov;86:603-15
12. Kulbertus HE. Transient hemiblock: An abnormal type of response to the Master two-step test. Am Heart J 1972; 83: 574-76.
13. Olivems RA, Seaworth J, Weiland FL, Boucher CA. Intermittent left anterior hemiblock during treadmill exercise test correlation with coronary arteriogram. Chest 1977; 72: 492-94
14. Takayama Y, Seki A, Imataka K, Fujii J. Exercise-induced QRS axis shift and its clinical significance. Jpn Heart J 1986; 27: 17-23.
15. Ogino K, Fukugi M, Hirai S et al. The usefulness of exercise-induced QRS axis shift as a predictor of coronary artery disease. Clin Cardiol 1988; 11: 101-104.
16. Karakas MF, Bilen E, Kurt M et al. The Correlation between Infarct Size and the QRS Axis Change after Thrombolytic Therapy in ST Elevation Acute Myocardial Infarction. Eurasian J Med 2012; 44: 13-17
17. Chandrasekar B, Loya YS, Sharma S, Paidhungat JV. Acute effect of balloon mitral valvotomy on serial electrocardiographic changes and their haemodynamic correlation. Indian Heart J 1998; 50: 179-82.
18. Goldberg A, Southern DA, Galbraith PD, Traboulsi M, Knudtson ML, Ghali WA. Coronary dominance and prognosis of patients with acute coronary syndrome. Am Heart J 2007; 154: 1116-22.
19. Veltman CE, de Graaf FR, Schuijf JD et al. Prognostic value of coronary vessel dominance in relation to significant coronary artery disease determined with non-invasive computed tomography coronary angiography. Eur Heart J 2012; 33: 1367-77.
20. Gebhard C, Fuchs TA, Stehli J et al. Coronary dominance and prognosis in patients undergoing coronary computed tomographic angiography: Results from the CONFIRM (coronary CT Angiography EvaluatioN For Clinical Outcomes: An International Multicenter) registry. Eur Heart J Cardiovasc Imaging 2015; 16: 853–62.
21. Vasheghani-Farahani A, Kassaian SE, Yaminisharif A et al. The association between coronary arterial dominancy and extent of coronary artery disease in angiography and paraclinical studies. Clin Anat 2008; 21: 519–23.
22. Zipes DP, Libby P, Bonow RO. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 7th ed. Philadelphia: W.B.Saunders; 2005
23. Kaimkhani ZA, Ali MM, Faruqi AM. Pattern of coronary arterial distribution and its relation to coronary artery diameter. J Ayub Med Coll Abbottabad 2005; 17: 40-43.
24. Virmani R, Chun PK, Robinowitz M, Goldstein RE, McAllister HA. Length of left main coronary artery. Lack of correlation to coronary artery dominance and bicuspid aortic valve: An autopsy study of 54 cases. Arch Pathol Lab Med 1984; 108: 638–641.
25. Balci B, Yilmaz O. Atherosclerotic involvement in patients with left or right dominant coronary circulation. Kardiol Pol 2004; 60: 564-66.
26. Abu-Assi E, Castineira-Busto M, Gonzalez-Salvado V et al. Coronary Artery Dominance and Long-term Prognosis in Patients With ST segment Elevation Myocardial Infarction Treated With Primary Angioplasty. Rev Esp Cardiol (Engl Ed) 2016; 69: 19–27.
27. Parikh NI, Honeycutt EF, Roe MT et al. Left and codominant coronary artery circulations are associated with higher in-hospital mortality among patients undergoing percutaneous coronary intervention for acute coronary syndromes: report From the National Cardiovascular Database Cath Percutaneous Coronary Intervention (CathPCI) Registry. Circ Cardiovasc Qual Outcomes 2012; 5: 775-82.
28. Veltman CE, Hoogslag GE, Kharbanda RK et al. Relation between coronary arterial dominance and left ventricular ejection fraction after ST-segment elevation acute myocardial infarction in patients having percutaneous coronary intervention. Am J Cardiol 2014; 114: 1646-50