Akut Serebrovasküler Olaylarda Malign Ventriküler Aritminin Risk Göstergeleri Olarak Tpe, Tpe Dispersiyon ve Tpe/QT Oraný

GÝRÝÞ ve AMAÇ: Akut iskemik strok (AÝS) ve akut hemorajik strokda (AHS) yeni ventriküler aritmi öngördürücüleri olan Tpeak-Tend (Tpe), Tpe dispersiyon (Tpe-d) ve Tpe/QT oraný’ýn deðiþimine dair sýnýrlý sayýda veri bulunmasýna raðmen, geçici iskemik atakta (GÝA) bu parametreler deðerlendirilmemiþtir. Bu çalýþmanýn amacý, GÝA’yý da dahil ederek ve daha detaylý bir elektrokardiyografik (EKG) analiz yaparak bu parametrelerin deðiþimini deðerlendirmektir.
YÖNTEM ve GEREÇLER: Bu prospektif çalýþmada hastalar, AÝS’lu 30 (ort. yaþ, 61.17±14.14 yýl; 15 kadýn/15 erkek), AHS’lu 20 (ort. yaþ, 65.05±9.50 yýl; 10 kadýn/10 erkek) ve GÝA’lý 30 hasta (ort. yaþ 58.10 ± 13.32 yýl; 15 kadýn/15 erkek) olmak üzere üç gruba ayrýldý. Yaþ ve cinsiyet uyumlu 30 saðlýklý birey kontrol grubu olarak alýndý. 12-lead EKG’den Tp-e, Tpe dispersiyon ve Tpe/QT oraný hesaplandý.
BULGULAR: AÝS ve AHS grubunda hem eski hem de yeni (Tpe, Tpe-d, Tpe/QT oraný) aritmi parametreleri GÝA ve kontrol grubu ile karþýlaþtýrýldýðýnda anlamlý þekilde uzamýþtý. Bu uzama V5 ve V6 derivasyonlarýna özgündü. Yaþ ile Tp-e, QTcmax ve QTd arasýnda pozitif korelasyon vardý (sýrasýyla r= 0.21, p= 0.028; r= 0.19, p= 0.032 ve r= 0.22, p= 0.013).
TARTIÞMA ve SONUÇ: Çalýþmamýz, GÝA’da Tpe, Tpe-d ve Tpe/QT gibi ventriküler repolarizasyon parametrelerinin deðiþmediðini ancak hem AÝS hem de AHS’un bu indeksleri arttýrdýðýný ortaya çýkardý. Bu durum, akut strok hastalarýnda ventriküler aritmi riskindeki artýþý açýklayabilir. Ayrýca akut strok hastalarýnda, EKG üzerinde V5 ve V6 leadleri ventriküler repolarizasyonu deðerlendirmede uygun leadler gibi görünmektedir.

Tpe, Tpe Dispersion and Tpe/QT Ratio as Risk Indicators of Malign Ventricular Arrhythmia In Acute Cerebrovascular Event

INTRODUCTION: Although there are limited data on the change of Tpeak-tend (Tpe), Tpe dispersion (Tpe-d) and Tpe/QT rate, which are new predictors of ventricular arrhythmias in acute ischemic stroke (AIS) and acute hemorrhagic stroke (AHS), these parameters have not been evaluated in the transient ischemic attack (TIA). The aim of this study is to evaluate the variation of these parameters by including the TIA and performing a more detailed electrocardiographic (ECG) analysis.
METHODS: In this prospective study, patients were put into three groups as 30 with AIS (mean age, 61.17±14.14 years; 15 women/15 men), 20 with AHS (mean age, 65.05±9.50 years; 10 women/10 men), and 30 with TIA (mean age 58.10±13.32 years; 15 women/15 men). Thirty sex- and age-matched healthy controls were recruited. Tp-e, Tpe-d and Tp-e/QT rate were calculated from 12-lead ECG.
RESULTS: In AIS and AHS both previous and new arrhythmia parameters were significantly more prolonged, compared to controls and patients with TIA. The prolonged parameter was specific to the derivations of V5 and V6. A positive correlation was present between the age, and Tpe, QTcmax and QTd (r= 0.21, p= 0.028; r= 0.19, p= 0.032; and, r= 0.22, p= 0.013, respectively)
DISCUSSION AND CONCLUSION: Our study revealed that ventricular repolarization parameters such as Tpe, Tpe-d and Tpe/QT do not change in TIA, however, both AIS and AHS increase these indexes. This may explain the increased risk of ventricular arrhythmias in acute stroke patients. Moreover, in acute stroke patients, leads V5 and V6 on the ECG appear to be suitable for assessing ventricular repolarization.