Hemodiyaliz hastalarında fragmente QRS ile ventriküler aritmiler arasındaki ilişki
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Dosyalar
Tarih
2021
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Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Fragmente QRS, 12 derivasyonlu EKG’ de görülebilen bir depolarizasyon kusurudur. Daha önce yapılan çeşitli klinik çalışmalarda fQRS' in morbidite ve mortaliteyi öngördürücü olduğu ortaya konulmuştur. Çalışmamız hemodiyaliz hastalarında, fQRS ile ventriküler aritmiler arasındaki ilişkiyi araştıran ilk çalışmadır. Hemodiyaliz hastalarında kardiyak aritmiler sıklıkla görülmektedir. Ventriküler aritmiler, hemodiyaliz hastalarında hayat kalitesini olumsuz etkileyebilmekte hatta ani kardiyak ölüme neden olabilmektedir. Bu araştırmada fQRS izlenen 22 hemodiyaliz hastası ile fQRS izlenmeyen 72 hemodiyaliz hastası karşılaştırıldı. İki grubun demografik verileri, biyokimyasal değerleri, EKG parametreleri, EKO verileri ve EKG-holter sonuçları karşılaştırıldı. Çalışmanın sonucunda her iki grubun demografik verileri, biyokimyasal değerleri ve ekokardiyografik verileri genel hatlarıyla birbirine yakındı. FQRS(+) grupta EKG parametrelerinden QTc, QTcd ve TDR sürelerinin uzadığı, istatistiksel olarak anlamlı olduğu görülmüştür(QTc, p: <0,001; QTcd, p:0,003; TDR, p:0,019). Ayrıca her iki grubun EKG- Holter verileri kıyaslandığında, fQRS(+) olan grupta VES sıklığı ve NSVT görülen olgu sayısının arttığı, istatistiksel olarak saptanmıştır ( VES, p: <0,001; NSVT, p:0,01). Saatte >30 adet VES sıklığının, VT ve mortalite gelişimi açısından öngördürücü bulgu olabileceğine yönelik literatür bilgileri mevcuttur. Biz de çalışmamızda bu nedenle >720 adet/24 saat VES sayısını kriter olarak belirledik ve grupların istatistiksel karşılaştırılmasında VES (+) grupta fQRS sıklığının arttığını ve çoklu regresyon analizinde bağımsız risk faktörü olduğunu saptadık. Ayrıca NSVT(+) grupta da fQRS sıklığının arttığını ve çoklu regresyon analizinde bağımsız risk faktörü olduğunu saptadık. Sonuç olarak, fQRS varlığı hemodiyaliz hastalarında ventriküler aritmileri öngörmede kullanılabilir. Böylece çalışmamız; hemodiyaliz hastalarının, kardiyovasküler semptomlar ve kardiyak mortalitenin azaltılmasına yönelik kullanılabilir. Bu alanda daha net ve kesin sonuçlara yaklaşılması ve gösterilmesi için çok merkezli ve randomize kontrollü çalışmaların gerçekleştirilmesi gerekmektedir.
Fragmente QRS is a depolarization defect that can be seen in a 12-derivation ECG. In several previous clinical research, it has been found that fQRS predicts morbidity and mortality. Our research is the first to investigate the relationship between fQRS and ventricular arrhythmias in hemodialysis patients. Cardiac arrhythmias are often observed in hemodialysis patients. Ventricular arrhythmias can negatively affect the quality of life in hemodialysis patients and even cause sudden cardiac death. In this study, 22 hemodialysis patients who were monitored by fQRS and 72 hemodialysis patients who were not monitored by fQRS were compared. Demographic data, biochemical values, ECG parameters, echo data and ECG-holter results of the two groups were compared. As a result of the study, the demographic data, biochemical values and echocardiographic data of the both groups were close to each other in general terms. It was observed that QTC, QTcd and TDR times were extended from ECG parameters in the FQRS(+) group and were statistically significant(QTc, p: <0.001; QTcd, p:0.003; TDR, p:0.019). In addition, compared to ECG - Holter data of the both groups, it was statistically detected that the frequency of VPC and the number of cases observed in NSVT increased in the group with fQRS (+) (VPC, p: <0.001; NSVT, p:0.01). There is literature information for being available that the frequency of VPC >30 per hour may be a predictive finding in terms of VT and mortality development. In our research, we therefore determined the number of VPC >720units/24 hours as a criterion and found that the frequency of fQRS increased in the VPC (+) group in statistical comparison of groups and that there was an independent risk factor in multiple regression analysis. Furthermore, we found that the frequency of fQRS increased in the NSVT (+) group and that there was an independent risk factor in multiple regression analysis, too. As a result, the presence of fQRS can be used to predict ventricular arrhythmias in hemodialysis patients. In this way, our study can be used to reduce cardiovascular symptoms and cardiac mortality in hemodialysis patients. In order to approach and demonstrate clearer and more accurate results in this area, it is necessary to conduct multicenter and randomized controlled trials.
Fragmente QRS is a depolarization defect that can be seen in a 12-derivation ECG. In several previous clinical research, it has been found that fQRS predicts morbidity and mortality. Our research is the first to investigate the relationship between fQRS and ventricular arrhythmias in hemodialysis patients. Cardiac arrhythmias are often observed in hemodialysis patients. Ventricular arrhythmias can negatively affect the quality of life in hemodialysis patients and even cause sudden cardiac death. In this study, 22 hemodialysis patients who were monitored by fQRS and 72 hemodialysis patients who were not monitored by fQRS were compared. Demographic data, biochemical values, ECG parameters, echo data and ECG-holter results of the two groups were compared. As a result of the study, the demographic data, biochemical values and echocardiographic data of the both groups were close to each other in general terms. It was observed that QTC, QTcd and TDR times were extended from ECG parameters in the FQRS(+) group and were statistically significant(QTc, p: <0.001; QTcd, p:0.003; TDR, p:0.019). In addition, compared to ECG - Holter data of the both groups, it was statistically detected that the frequency of VPC and the number of cases observed in NSVT increased in the group with fQRS (+) (VPC, p: <0.001; NSVT, p:0.01). There is literature information for being available that the frequency of VPC >30 per hour may be a predictive finding in terms of VT and mortality development. In our research, we therefore determined the number of VPC >720units/24 hours as a criterion and found that the frequency of fQRS increased in the VPC (+) group in statistical comparison of groups and that there was an independent risk factor in multiple regression analysis. Furthermore, we found that the frequency of fQRS increased in the NSVT (+) group and that there was an independent risk factor in multiple regression analysis, too. As a result, the presence of fQRS can be used to predict ventricular arrhythmias in hemodialysis patients. In this way, our study can be used to reduce cardiovascular symptoms and cardiac mortality in hemodialysis patients. In order to approach and demonstrate clearer and more accurate results in this area, it is necessary to conduct multicenter and randomized controlled trials.
Açıklama
Anahtar Kelimeler
Fragmente QRS, Hemodiyaliz, Ventriküler aritmiler, Ani kardiyak ölüm, EKG, EKG-Holter, Hemodialysis, Ventricular arrhythmias, Sudden cardiac death, ECG, ECG-Holter
