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Öğe The clinical significance of QTc dispersion measurement for risk of syncope in patients with aortic stenosis(Futura Publishing Company Inc., 2001) Koşar F.; Tando?an I.; Hisar I.; Aytan Y.; Ileri M.Objectives: (1) To evaluate the clinical usefulness of QTc dispersion determination in aortic stenosis and (2) to compare the effects of QTc dispersion on the occurrence risk of syncope in aortic stenosis. Background: QT interval dispersion has long been known to be a marker of dispersion of ventricular repolarization and, hence, electrical instability. Additionally, it has been shown that these patients have a propensity to ventricular tachyarrhythmic syncope. Methods: The study included 86 patients with aortic stenosis who underwent left-heart catheterization and coronary angiography during investigation of syncope, as well as 30 control subjects. The patients were characterized with regards to the presence or absence of a history of syncope and the severity of aortic stenosis (the degree of peak transvalvular gradient). In addition, QT dispersion measurements were corrected for heart rate according to Bazett's formula and both were measured. Results: QTc dispersion was greater in patients with aortic stenosis than in the control subjects (60 ± 13 msec vs 38 ± 12 msec, P < 0.001). Similarly, QTc dispersion was greater in the patients with a history of syncope than in the patients with no history of syncope (68 ± 12 msec vs 53 ± 10 msec, P < 0.001). In addition, QTc dispersion values were greater in the patients with a high transvalvular gradient than in the patients with a low transvalvular gradient (65 ± 12 msec vs 50 ± 9 reset, P < 0.001). Multivariate logistic regression analysis showed that only an increased QTc dispersion had significant value for the risk of syncope in aortic stenosis. Conclusions: An increased QTc dispersion increases the occurrence risk for syncope in aortic stenosis. These results suggest that high values of QTc dispersion are a sensitive noninvasive marker for determining the risk for syncope in aortic stenosis.Öğe Increased P-wave duration and P-wave dispersion in patients with aortic stenosis(Turkish Anaesthesiology and Intensive Care Society, 2002) Turhan H.; Yetkin E.; Şenen K.; Ileri M.; Atak R.; Biçer A.; Şaşmaz H.P-wave dispersion (PWD), defined as the difference between maximum and minimum P-wave duration, has been reported as being useful for the prediction of paroxysmal atrial fibrillation (AF). AF is the most common arrhythmia and an important prognostic indicator for clinical deterioration in patients with aortic stenosis (AS). The aim of the present study was to evaluate PWD in patients with AS. The study population consisted of two groups: Group I consisted of 98 patients with degenerative AS (76 men, 22 women; aged 63±8 years) and group II consisted of 98 age and sex matched healthy subjects without any cardiovascular disease. Twelve-lead electrocardiogram was recorded for each subject. The P-wave duration was calculated in all leads of the surface electrocardiogram. The difference between the maximum and minimum P-wave duration was calculated and this difference was defined as PWD. All patients and control subjects were also evaluated by echocardiography to measure the left atrial diameter, left ventricular ejection fraction, left ventricular wall thicknesses, maximum and mean aortic gradients. Patients were also evaluated for the presence of documented paroxysmal AF. Maximum P-wave duration (126 ms) and PWD of group I were found to be significantly higher than those of group II (108 ms). In addition, patients with paroxysmal AF (130 ms) had significantly higher PWD (121 ms) than those without paroxysmal AF. There was no significant difference between two groups regarding minimum P-wave duration. There was no significant correlation between echocardiographic variables and PWD. PWD, indicating increased risk for paroxysmal AF, was found to be significantly higher in patients with AS than in those without it. Further assessment of the clinical utility of PWD for the prediction of paroxysmal AF in patients with severe AS will require longer prospective studies.Öğe Relationship between myocardial viability and the predischarge electrocardiographic pattern in patients with first anterior wall acute myocardial infarction(2003) Atak R.; Turhan H.; Senen K.; Ileri M.; Yetkin E.; Ozbakir C.; Demirkan D.Background: The assessment of residual viability in the infarcted area after an acute myocardial infarction is relevant to subsequent management and prognosis. Objective: The aim of this study was to investigate the correlation between myocardial viability after an acute anterior myocardial infarction (AMI) as assessed by low dose dobutamine stress echocardiography (LDDSE) and the electrocardiographic patterns of ST segment and T wave abnormalities at the end of the first week of the acute event. Methods: Sixty-nine consecutive patients (51 men, 18 women, mean age±standard deviation=57±11 years) who admitted to our clinic due to a first episode of transmural AMI were included in this study. Two-dimensional echocardiography was performed to all patients during rest and low dose dobutamine administration at the end of the first week of admission (7±2 days). Patients were classified into four groups according to ST segment and T wave morphology: group A, ST elevation ?0.1 mV and negative T waves; group B, ST elevation ?0.1 mV and positive T waves; group C, ST elevation ?0.1 mV and negative T waves and group D, ST elevation ?0.1 mV and positive T waves. Results: Myocardial viability was detected more often in patients with isoelectric ST segments (22/24, 92%) than those with elevated ST segments (21/45, 47%) (P<0.001). Similarly patients with negative T waves had myocardial viability more frequently compared to those with positive T waves (32/45, 71% vs. 11/24, 46%, P<0.01). Seventeen (94%) of 18 patients in group A and 5 (83%) of six patients in group B had viable myocardium (P>0.05). Myocardial viability was found in 15 (56%) of 27 patients in group C and six (33%) of 18 patients in group D (P<0.01). As a marker of viable myocardium, isoelectricity of ST segment was specific (92%) but only moderately sensitive (51%), with a 92% positive predictive accuracy and a poor (53%) negative predictive value. T wave negativity was less spesific but more sensitive than isoelectricity of ST segment for myocardial viability. Conclusion: The presence of isoelectric ST segment and negative T wave indicates a high probability of myocardial viablitiy. However, absence of these electrocardiographic patterns does not exclude the presence of viable myocardium. © 2003 Elsevier Ireland Ltd. All rights reserved.
