RS zamanı ile kronik obstrüktif akciğer hastalığının şiddeti arasındaki ilişki

Yıl 2021, Cilt: 46 Sayı: 2, 756 - 763, 30.06.2021

İbrahim Yıldız , Pınar Özmen Yıldız Hüsamettin Sazlıdere Mehmet Sait Gürevin İbrahim Rencüzoğulları , Yavuz Karabağ , Cengiz Burak Çağlar Özmen

https://doi.org/10.17826/cumj.895173

Öz

Amaç: Çalışmamızın amacı, elektrokardiyogramdan ölçülen RS zamanının kronik obstrüktif akciğer hastalığı (KOAH) şiddeti ile ilişkili olup olmadığını belirlemekti.
Gereç ve Yöntem: Çalışma popülasyonu, ortalama yaşı 63 ± 10 yıl olan (% 86 erkekti) 100 KOAH hastasından oluştu. Kronik Obstrüktif Akciğer Hastalığına Karşı Küresel Girişim (GOLD) aşamalarına göre bu hastalar hafif ve orta derecede KOAH (GOLD 1–2) grubu (s = 45) ve şiddetli ve çok şiddetli KOAH (GOLD 3–4) grubuna (s = 55) ayrıldı. Bu gruplar birbirleriyle karşılaştırıldı.
Bulgular: Şiddetli ve çok şiddetli KOAH'lı hastalarda kalp hızı, P dalga aksı, QRS ekseni, RS zamanı ve sağ dal bloğu insidansı anlamlı olarak daha yüksekti. Çok değişkenli analizde, kalp hızı, P dalga aksı ve RS zamanı (olasılık oranı = 1.081) şiddetli ve çok şiddetli KOAH'ın bağımsız belirleyicileriydi. Alıcı işletim karakteristik eğrisi analizi, şiddetli ve çok şiddetli KOAH tahmini için en iyi RS zaman kesme değerinin, % 69,1 duyarlılık ve % 66,7 özgüllük ile 60 ms olduğunu gösterdi.
Sonuç: Bir elektrokardiyogramda basitçe ölçülen RS zamanı, şiddetli ve çok şiddetli KOAH'lı hastaların hızlı tahmini için yararlı bir tarama testi olabilir.

Anahtar Kelimeler

kronik obstrüktif akciğer hastalığı, elektrokardiyografi, elektrofizyoloji

Relationship between RS time and the severity of chronic obstructive pulmonary disease

Öz

Purpose: The aim of our study was to determine whether the RS time measured on an electrocardiogram is associated with the severity of chronic obstructive pulmonary disease (COPD).
Materials and Methods: The study population was made up of 100 COPD patients with a mean age of 63 ± 10 years (86% were males). These patients were divided into the mild and moderate COPD (GOLD 1–2) group (n = 45) and the severe and very severe COPD (GOLD 3–4) group (n = 55) according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages. These groups were compared with each other.
Results: Heart rate, P wave axis, QRS axis, RS time, and incidence of right bundle branch block were significantly higher in patients with severe and very severe COPD. In the multivariable analysis, heart rate, P wave axis, and RS time (odds ratio = 1.081) were the independent predictors of severe and very severe COPD. The receiver operating characteristic curve analysis showed that the best RS time cutoff value for the prediction of severe and very severe COPD was 60 ms, with a sensitivity of 69.1% and a specificity of 66.7%.
Conclusion: RS time simply measured on an electrocardiogram may be a useful screening test for the quick estimation of patients with severe and very severe COPD.

Anahtar Kelimeler

chronic obstructive pulmonary disease, electrocardiography, electrophysiology

Kaynakça

• 1. Biener AI, Decker SL, Rohde F. Prevalence and Treatment of Chronic Obstructive Pulmonary Disease (COPD) in the United States. JAMA. 2019; 322(7): 602.
• 2. Hurd S. The impact of COPD on lung health worldwide: epidemiology and incidence. Chest. 2000; 117(2 Suppl): 1S-4S.
• 3. Sin DD, Wu L, Man SF. The relationship between reduced lung function and cardiovascular mortality: a population-based study and a systematic review of the literature. Chest. 2005; 127(6): 1952-9.
• 4. Sakao S, Voelkel NF, Tatsumi K. The vascular bed in COPD: pulmonary hypertension and pulmonary vascular alterations. Eur Respir Rev. 2014; 23: 350-5.
• 5. Peinado VI, Pizarro S, Barberà JA. Pulmonary vascular involvement in COPD. Chest. 2008; 134(4): 808-14.
• 6. Hilde JM, Skjørten I, Grøtta OJ, Hansteen V, Melsom MN, Hisdal J, et al. Right ventricular dysfunction and remodeling in chronic obstructive pulmonary disease without pulmonary hypertension. J Am Coll Cardiol. 2013; 62(12): 1103-1111.
• 7. Scott RC. The electrocardiogram in pulmonary emphysema and chronic cor pulmonale. Am Heart J. 1961; 61: 843-5.
• 8. Burch GE, Depasquale NP. The electrocardiographic diagnosis of pulmonary heart disease. Am J Cardiol 1963; 11: 622-38.
• 9. Rencuzogullari I, Çağdaş M, Karabağ Y, Karakoyun S, Çiftçi H, Gürsoy MO, et al. A novel ECG parameter for diagnosis of acute pulmonary embolism: RS time: RS time in acute pulmonary embolism. Am J Emerg Med. 2019; 37(7) :1230-1236.
• 10. Buklioska-Ilievska D, Minov J, Kochovska-Kamchevska N, Prgova-Veljanova B, Petkovikj N, Ristovski V, et al. Cardiovascular Comorbidity in Patients with Chronic Obstructive Pulmonary Disease: Echocardiography Changes and Their Relation to the Level of Airflow Limitation. Open Access Maced J Med Sci. 2019; 7: 3568-3573.
• 11. Kaushal M, Shah PS, Shah AD, Francis SA, Patel NV, Kothari KK. Chronic obstructive pulmonary disease and cardiac comorbidities: A cross-sectional study. Lung India. 2016; 33(4):404-9.
• 12. Bhatta L, Leivseth L, Mai XM, Henriksen AH, Carslake D, Chen Y, et al. GOLD Classifications, COPD Hospitalization, and All-Cause Mortality in Chronic Obstructive Pulmonary Disease: The HUNT Study. Int J Chron Obstruct Pulmon Dis. 2020; 15: 225-233.
• 13. Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, et al; Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007; 176(6): 532-55.
• 14. Dilaveris PE, Gialafos EJ, Sideris SK, Theopistou AM, Andrikopoulos GK, Kyriakidis M, et al.: Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J. 1998; 135(5 Pt 1): 733-8.
• 15. Bazett HC. An analysis of time relations of electrocardiograms. Heart. 1920; 7: 353-370.
• 16. Standardization of Spirometry, 1994 Update. American Thoracic Society. Am J Respir Crit Care Med. 1995; 152(3): 1107-36.
• 17. Gupta NK, Agrawal RK, Srivastav AB, Ved ML. Echocardiographic evaluation of heart in chronic obstructive pulmonary disease patient and its co-relation with the severity of disease. Lung India. 2011; 28(2): 105-9.
• 18. Rodman DM, Lowenstein SR, Rodman T. The electrocardiogram in chronic obstructive pulmonary disease. J Emerg Med. 1990; 8(5): 607-15.
• 19. Cimci M, Borekci S, Kilickiran Avci B, Hysi E, Ongen HG, Karadag B, et al. Assessment of atrial electromechanical delay and P wave dispersion in patients with chronic obstructive pulmonary disease.Turk Kardiyol Dern Ars. 2020; 48(3): 263-269.
• 20. Spodick DH. Electrocardiographic studies in pulmonary disease. II. Establishment of criteria for the electrocardiographic inference of diffuse lung diseases. Circulation. 1959; 20: 1073-4.
• 21. Chhabra L, Sareen P, Perli D, Srinivasan I, Spodick DH. Vertical P-wave axis: the electrocardiographic synonym for pulmonary emphysema and its severity. Indian Heart J. 2012; 64(1): 40-2.
• 22. Larssen MS, Steine K, Hilde JM, Skjørten I, Hodnesdal C, Liestøl K, et al. Mechanisms of ECG signs in chronic obstructive pulmonary disease. Open Heart. 2017; 4: e000552.
• 23. Warnier MJ, Rutten FH, Numans ME, Kors JA, Tan HL, de Boer A, et al. Electrocardiographic characteristics of patients with chronic obstructive pulmonary disease. COPD. 2013; 10(1): 62-71.
• 24. Barr RG, Bluemke DA, Ahmed FS, Carr JJ, Enright PL, Hoffman EA, et al. Percent emphysema, airflow obstruction, and impaired left ventricular filling. N Engl J Med. 2010; 362(3): 217-27.
• 25. Burch GE, DePasquale N. The electrocardiogram, spatial vectorcardiogram, and ventricular gradient in congenital ventricular septal defect. Am Heart J. 1960; 60: 195-211.
• 26. Gümüşdağ A, Burak C, Suleymanoglu M, Yesin M, Tanık VO, Karabağ Y, et al. The predictive value of RS time for short term mortality in patients with acute pulmonary embolism. J Electrocardiol. 2020; 62: 94-99.
• 27. Park DH, Cho KI, Kim YK, Kim BJ, You GI, Im SI, et al. Association between right ventricular systolic function and electromechanical delay in patients with right bundle branch block. J Cardiol. 2017; 70: 470-475.
• 28. Watz H, Waschki B, Meyer T, Kretschmar G, Kirsten A, Claussen M, et al. Decreasing cardiac chamber sizes and associated heart dysfunction in COPD: role of hyperinflation. Chest. 2010; 138(1): 32-8.