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EVALUATION OF P WAVE DISPERSION IN ECG; QT DISPERSION AND OTHER ECG CHANGES IN PATIENTS ADMITTED TO EMERGENCY DUE TO STROKE

Year 2017, Volume: 2 Issue: 3, 42 - 55, 15.12.2017

Abstract

Aims: In this, a comparison ofQT, QTc, QTdis, P wave and Pdis values from the
first ECG recordings in stroke patients and healthy individuals in emergency
department was realized, and it was searched whether these values were predictors
of prognosis within gender and age or not.

Materials and methods:Along with a control group of  90 patients, 76 patients with a diagnosis on ischemic stroke presenting
neurological symptoms and brain CT and / or MRI evaluation in the emergency
room were included in the study. All patients were analysed with 12-lead
electrocardiograms and PMAX, PMIN, pdis, QT, QTc, QTDIS and QTCDIS intervals
were measured.

Results:During the Pdis comparison in control and stroke groups,
interval wasdetected significantly higher in the stroke group[95% CI; 39.55 to
49.40] compared to the control group [95% CI; 26.55 to 33.45]. QTDİS[95% CI; Vs
49.16 to 62.28 39.28 to 46.82] and QTCDİSvalues [95% CI; 54.22 to 72.83 vs
43,10-51,1739,28-46,82] werealso detected statistically meaningful in stroke
group compared to control cases.







Conclusion:Pdis, QTDIS and QTCDIS intervals that were determined to
be prolonged in stroke gropus compared to the control group should be
considered as important parameters in prognosis and clinical follow-up.

References

  • 1. Stroke drops to fourth leading cause of death in 2008. Atlanta,GA: Centers for Disease Control and Prevention; December 9, 2010. http://www.cdc.gov/media/pressrel/2010/r101209.html.Accessed June 20, 2011.
  • 2. Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW Jr, Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H; American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on Peripheral Vascular Disease; Council on Clinical CardiologyGuidelines forthe early management of patients with acute ischemic stroke: aguideline for healthcare professionals from the American Heart Association/AmericanStroke Association. Stroke. 2013 Mar;44(3):870-947.
  • 3. Lazzaro MA, Krishnan K, Prabhakaran S. Detection of atrial fibrillation with concurrent holter monitoring and continuous cardiac telemetry following ischemic stroke and transient ischemic attack. J Stroke Cerebrovasc Dis. 2012 Feb;21(2):89-93.
  • 4. Douen AG, Pageau N, Medic S. Serial electrocardiographic assessments significantly improve detection of atrial fibrillation 2.6-fold in patients with acute stroke. Stroke. 2008 Feb;39(2):480-2.
  • 5. Grond M, Jauss M, Hamann G, Stark E, Veltkamp R, Nabavi D, Horn M, Weimar C, Köhrmann M, Wachter R, Rosin L, Kirchhof P. Improved detection of silent atrial fibrillation using 72-hour Holter ECG in patients with ischemic stroke: a prospective multicenter cohort study. Stroke. 2013 Dec;44(12):3357-64.
  • 6. Dilaveris PE, Gialafos EJ, Sideris SK, et al. Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J. 1998 May;135(5 Pt 1):733-8.).
  • 7. Dogan U, Dogan EA, Tekinalp M, Tokgoz OS, Aribas A, Akilli H, Ozdemir K, Gok H, Yuruten B. P-wave Dispersion for Predicting Paroxysmal Atrial Fibrillation in Acute Ischemic Stroke. Int J Med Sci 2012; 9(1):108-114
  • 8. Lazar J, Manzella S, Moonjelly J, Wirkowski E, Cohen TJ. The prognostic value of QT dispersion in patients presenting with acute neurological events. J Invasive Cardiol. 2003 Jan;15(1):31-5.
  • 9. N. Afsar, A.S. Fak, J.T. Metzger, G. Van Melle, L. Kappenberger, J. Bogousslavsky. Acute stroke increases QT dispersion in patients without known cardiac diseases. Arch Neurol, 60 (3) (2003), pp. 346–350
  • 10. Lederman YS, Balucani C, Lazar J, Steinberg L, Gugger J, Levine SR. Relationship between QT Interval Dispersion in Acute Stroke and Stroke Prognosis: A Systematic Review. J Stroke Cerebrovasc Dis. 2014 Oct 1.pii: S1052-3057(14)00286-9.
  • 11. Kocer A, Barutcu I, Atakay S, Ozdemirli B, Gul L, Karakaya O. P wave duration changes and dispersion. A risk factor or autonomic dysfunction in stroke? Neurosciences (Riyadh). 2009 Jan;14(1):14-8.Neurol. 1999; 42(4): 190–193)
  • 12. (http://www.openepi.com/SampleSize/SSMean.htm).
  • 13. The World health report 2004. Annex Table 2: Deaths by cause, sex and mortality stratum in WHO regions, estimates for 2002. Geneva: World Health Organization 2004
  • 14. Oppenheimer SM. Neurogenic cardiac effects of cerebrovascular disease. Curr Op Neurol 1994; 7: 20-24
  • 15. Robinson TG, James M, Youde J, Panerai R, Potter J. Cardiac baroreceptor is impaired after acute stroke. Stroke 1997;28:1671-6.
  • 16. Yoshida N, Nozawa T, Igawa A, et al. Modulation of ventricular repolarization and R-R interval is altered in patients with globally impaired cardiac 123I-MIBG uptake. Ann Noninvasive Electrocardiol 2001;6:55-63.
  • 17. Nakagawa M, Takahashi N, Iwao T, et al. Evaluation of autonomic influences on QT dispersion using the head-up tilt test in healthy subjects. Pacing Clin Electrophysiol 1999;22:1158-63.
  • 18. Korpelainen JT, Sotaniemi KA, Suominen K, Tolonen U, Myllylä VV. Cardiovascular autonomic reflexes in brain infarction. Stroke 1994;24:787-92
  • 19. Tokgözoglu SL, Batur MK, Top uoglu MA, Saribas O, Kes S, Oto A. Effects of stroke localization on cardiac autonomic balance and sudden death. Stroke 1999;30:1307-11.
  • 20. Daniele O, Caravaglios G, Fierro B, Natalè E. Stroke and cardiac arrhythmias. J Stroke Cerebrovasc Dis. 2002 Jan-Feb;11(1):28-33.
  • 21. Umuttan Dogan, Ebru Apaydin Dogan, Mehmet Tekinalp et all. P-wave Dispersion for Predicting Paroxysmal Atrial Fibrillation in Acute Ischemic Stroke, Int. J. Med. Sci. 2012, 9)
  • 22. Lazar J, Busch D, Wirkowski E, Clark LT, Salciccioli L. Changes in QT dispersion after thrombolysis for stroke. . Int J Cardiol. 2008 Apr 10;125(2):258-62)
  • 23. Eckardt M, Gerlach L, Welter FL.Prolongation of the frequency-corrected QT dispersion following cerebral strokes with involvement of the insula of Reil. Eur
  • 24. Lazar JM, Salciccioli L. Prognostic value of QT dispersion in acute stroke. Int J Cardiol. 2008 Sep 16;129(1):1-2.

İNMEYLE BAŞVURULAN ACİL DURUM HASTALARINDA: P DALGA DİSPERSİYONU, QT DISPERSION VE DİĞER EKG DEĞİŞİKLİKLERİ

Year 2017, Volume: 2 Issue: 3, 42 - 55, 15.12.2017

Abstract

Amaç: Bu çalışmada, acil
serviste  inme hastalarında ve sağlıklı bireylerde ilk EKG kayıtlarından
QT, QTc, QTdis, P dalga ve Pdis değerlerinin karşılaştırılması yapıldı ve bu
değerlerin cinsiyet ve yaş açısından prognoz belirleyicileri olup olmadığı
araştırıldı.Gereç ve yöntem: 90 hastadan oluşan bir kontrol grubu ile birlikte,
nörolojik semptomları olan ve iskemik inme tanısı konan 76 hastanın acil
serviste beyin BT ve / veya MRG değerlendirmesi yapıldı. Tüm hastalar 12
derivasyonlu elektrokardiyografi ile analiz edildi ve PMAX, PMIN, pdis, QT,
QTc, QTDIS ve QTCDIS aralıkları ölçüldü.

Bulgular: Kontrol grubu ve
inme gruplarındaki Pdis karşılaştırması sırasında, aralık inmeli grupta [% 95
CI; 39.55 ila 49.40] kontrol grubuna [% 95 CI; 26.55 ila 33.45]. QTDİS [% 95
CI; Vs 49.16 ila 62.28 39.28 ila 46.82] ve QTCDİS değerleri [% 95 CI; 54.22 ila
72.83'e karşılık 43,10-51,1739,28-46,82] kontrol gruplarına kıyasla inmeli
grupta istatistiksel olarak anlamlı bulundu.





Sonuç: Prognoz ve klinik
takipte inme grubunda kontrol grubuna göre uzamış olduğu saptanan Pdis, QTDIS
ve QTCDIS değerleri önemli parametreler olarak düşünülmelidir.

References

  • 1. Stroke drops to fourth leading cause of death in 2008. Atlanta,GA: Centers for Disease Control and Prevention; December 9, 2010. http://www.cdc.gov/media/pressrel/2010/r101209.html.Accessed June 20, 2011.
  • 2. Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW Jr, Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H; American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on Peripheral Vascular Disease; Council on Clinical CardiologyGuidelines forthe early management of patients with acute ischemic stroke: aguideline for healthcare professionals from the American Heart Association/AmericanStroke Association. Stroke. 2013 Mar;44(3):870-947.
  • 3. Lazzaro MA, Krishnan K, Prabhakaran S. Detection of atrial fibrillation with concurrent holter monitoring and continuous cardiac telemetry following ischemic stroke and transient ischemic attack. J Stroke Cerebrovasc Dis. 2012 Feb;21(2):89-93.
  • 4. Douen AG, Pageau N, Medic S. Serial electrocardiographic assessments significantly improve detection of atrial fibrillation 2.6-fold in patients with acute stroke. Stroke. 2008 Feb;39(2):480-2.
  • 5. Grond M, Jauss M, Hamann G, Stark E, Veltkamp R, Nabavi D, Horn M, Weimar C, Köhrmann M, Wachter R, Rosin L, Kirchhof P. Improved detection of silent atrial fibrillation using 72-hour Holter ECG in patients with ischemic stroke: a prospective multicenter cohort study. Stroke. 2013 Dec;44(12):3357-64.
  • 6. Dilaveris PE, Gialafos EJ, Sideris SK, et al. Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J. 1998 May;135(5 Pt 1):733-8.).
  • 7. Dogan U, Dogan EA, Tekinalp M, Tokgoz OS, Aribas A, Akilli H, Ozdemir K, Gok H, Yuruten B. P-wave Dispersion for Predicting Paroxysmal Atrial Fibrillation in Acute Ischemic Stroke. Int J Med Sci 2012; 9(1):108-114
  • 8. Lazar J, Manzella S, Moonjelly J, Wirkowski E, Cohen TJ. The prognostic value of QT dispersion in patients presenting with acute neurological events. J Invasive Cardiol. 2003 Jan;15(1):31-5.
  • 9. N. Afsar, A.S. Fak, J.T. Metzger, G. Van Melle, L. Kappenberger, J. Bogousslavsky. Acute stroke increases QT dispersion in patients without known cardiac diseases. Arch Neurol, 60 (3) (2003), pp. 346–350
  • 10. Lederman YS, Balucani C, Lazar J, Steinberg L, Gugger J, Levine SR. Relationship between QT Interval Dispersion in Acute Stroke and Stroke Prognosis: A Systematic Review. J Stroke Cerebrovasc Dis. 2014 Oct 1.pii: S1052-3057(14)00286-9.
  • 11. Kocer A, Barutcu I, Atakay S, Ozdemirli B, Gul L, Karakaya O. P wave duration changes and dispersion. A risk factor or autonomic dysfunction in stroke? Neurosciences (Riyadh). 2009 Jan;14(1):14-8.Neurol. 1999; 42(4): 190–193)
  • 12. (http://www.openepi.com/SampleSize/SSMean.htm).
  • 13. The World health report 2004. Annex Table 2: Deaths by cause, sex and mortality stratum in WHO regions, estimates for 2002. Geneva: World Health Organization 2004
  • 14. Oppenheimer SM. Neurogenic cardiac effects of cerebrovascular disease. Curr Op Neurol 1994; 7: 20-24
  • 15. Robinson TG, James M, Youde J, Panerai R, Potter J. Cardiac baroreceptor is impaired after acute stroke. Stroke 1997;28:1671-6.
  • 16. Yoshida N, Nozawa T, Igawa A, et al. Modulation of ventricular repolarization and R-R interval is altered in patients with globally impaired cardiac 123I-MIBG uptake. Ann Noninvasive Electrocardiol 2001;6:55-63.
  • 17. Nakagawa M, Takahashi N, Iwao T, et al. Evaluation of autonomic influences on QT dispersion using the head-up tilt test in healthy subjects. Pacing Clin Electrophysiol 1999;22:1158-63.
  • 18. Korpelainen JT, Sotaniemi KA, Suominen K, Tolonen U, Myllylä VV. Cardiovascular autonomic reflexes in brain infarction. Stroke 1994;24:787-92
  • 19. Tokgözoglu SL, Batur MK, Top uoglu MA, Saribas O, Kes S, Oto A. Effects of stroke localization on cardiac autonomic balance and sudden death. Stroke 1999;30:1307-11.
  • 20. Daniele O, Caravaglios G, Fierro B, Natalè E. Stroke and cardiac arrhythmias. J Stroke Cerebrovasc Dis. 2002 Jan-Feb;11(1):28-33.
  • 21. Umuttan Dogan, Ebru Apaydin Dogan, Mehmet Tekinalp et all. P-wave Dispersion for Predicting Paroxysmal Atrial Fibrillation in Acute Ischemic Stroke, Int. J. Med. Sci. 2012, 9)
  • 22. Lazar J, Busch D, Wirkowski E, Clark LT, Salciccioli L. Changes in QT dispersion after thrombolysis for stroke. . Int J Cardiol. 2008 Apr 10;125(2):258-62)
  • 23. Eckardt M, Gerlach L, Welter FL.Prolongation of the frequency-corrected QT dispersion following cerebral strokes with involvement of the insula of Reil. Eur
  • 24. Lazar JM, Salciccioli L. Prognostic value of QT dispersion in acute stroke. Int J Cardiol. 2008 Sep 16;129(1):1-2.
There are 24 citations in total.

Details

Journal Section Makale
Authors

Erhan Dedeoglu This is me

Başak Bayram

Mahmut Fırat Kaynak

Erdinç Öz This is me

Publication Date December 15, 2017
Acceptance Date December 15, 2017
Published in Issue Year 2017 Volume: 2 Issue: 3

Cite

Vancouver Dedeoglu E, Bayram B, Kaynak MF, Öz E. İNMEYLE BAŞVURULAN ACİL DURUM HASTALARINDA: P DALGA DİSPERSİYONU, QT DISPERSION VE DİĞER EKG DEĞİŞİKLİKLERİ. JAMER. 2017;2(3):42-55.