Koroner Yavaş Akım Fenomeni Olan Hastalarda Kardiyak Elektrofizyolojik Denge Endeksinin Değerlendirilmesi

Yıl 2023, Cilt: 14 Sayı: 1, 43 - 47, 23.03.2023

Metin Okşul , Mehmet Şahin Adıyaman

https://doi.org/10.18663/tjcl.1228430

Öz

Amaç: Koroner yavaş akım (KYA) fenomeni koroner arterlerde anlamlı darlık olmadan yavaş akımla karakterize olan bir klinik antitedir ve koroner anjiyografilerin yaklaşık %3'ünde görülmektedir. KYA'nın nadiren de olsa ventriküler aritmiler ve ani kardiyak ölümle ilişkili olduğu bilinmektedir. Kardiyak elektrofizyolojik denge endexi (index of cardiac electrophysiological balance = iCEB), 12 derivasyonlu EKG'de QT intervalinin QRS süresine bölünmesi ile elde edilen non-invaziv bir parametredir. Bu parametrenin normalden sapmasının malign ventriküler aritmiler ile ilişkili olduğu gösterilmiştir. Bu çalışma ile amacımız KYA olan hastalarda kontrol grubuna göre iCEB farklılığını ve iCEB 'in yavaş koroner akım olan arter sayısı ile ilişkisini değerlendirmektir.
Gereç ve Yöntemler : Çalışmamıza toplamda 189 hasta dahil edildi (KYA: 91, kontrol: 98). KYA olan hastalar tek damar KYA ve çok damar KYA olarak 2 gruba ayrıldı (tek damar KYA:60, çok damar KYA:31). Her iki grubun demografik, klinik, laboratuvar ve elektrokardiyografik parametreleri karşılaştırıldı.
Bulgular : Çalışmaya alınan hastalardan KYA hastalarında median yaş 52 (45-59) kontrol grubunda 50 (43-56) saptandı (p=0,186). KYA hastalarının % 45,1'i ; kontrol hastalarının %62.2 si kadındı (p=0,018) . Median kreatinin düzeyi KYA hastalarında daha yüksek ( 0,81 vs 0,72, p=0,015) , HDL düzeyi KYA hastalarında daha düşük saptandı (39 vs. 43, p=0,033). Median iCEB değerleri KYA grubunda kontrol grubuna göre anlamlı olarak daha yüksekti (4,18 vs. 4,07, p=0,006). Tek damar KYA ve çok damar KYA hastalarının karşılaştırıldığı analizde bazal karakteristik özellikler arasında fark yoktu ve iCEB değerleri arasında istatistiksel olarak anlamlı fark bulunamadı (4,18 vs. 4,15 p=0,391).
Sonuçlar: Çalışmamızın sonucunda KYA hastalarında iCEB değeri , kontrol grubuna göre anlamlı olarak daha yüksek bulundu. Bununla beraber tek damar KYA ve çok damar KYA hastalarında iCEB değerleri açısından anlamlı fark bulunamadı. KYA'da artmış iCEB 'in görülmesi, bu hasta grubunda ventriküler aritmilerle ilişkilendirilebilir. Bu parametrelerin yakından izlenmesi, olası ventriküler aritmilerin öngörülebilmesi ve yüksek riskli hastalarda daha agresif bir tedavi yaklaşımın sergilenmesi açısından yol gösterici olabilir.

Anahtar Kelimeler

kardiyak elektrofizyolojik denge endeksi, koroner yavaş akım, ventriküler aritmi, İndex of cardiac electrophysiological balance, coronary slow flow, ventricular arrhythmia

Evaluation of İndex of Cardiac electrophysiological Balance in Patients with Coronary Slow Flow Phenomenon

Öz

Aim: Coronary slow flow (CSF) phenomenon is a clinical entity characterized by slow flow without significant stenosis in the coronary arteries and is observed in approximately 3% of coronary angiographies. It is known that CSF is associated, although rarely, with ventricular arrhythmias and sudden cardiac death. The index of cardiac electrophysiological balance (iCEB) is a non-invasive parameter obtained by dividing the QT interval by the QRS time on a 12-lead ECG. It has been shown that the deviation of this parameter from normal is associated with malignant ventricular arrhythmias. Our aim with this study was to evaluate the difference in iCEB in patients with CSF compared to the control group and the relationship of iCEB with the number of arteries with slow coronary flow.
Material and Methods : A total of 189 patients were included in our study (CSF: 91, control: 98). Patients with KYA were divided into 2 groups as single-vessel CSF and multi-vessel CSF (single-vessel CSF:60, multi-vessel CSF:31). Demographic, clinical, laboratory and electrocardiographic parameters of both groups were compared.
Results : The median age of the patients enrolled in the study was 52 (45-59) in CSF patients and 50 (43-56) in the control group (p=0.186). 45.1% of CSF patients and 62.2% of control patients were female (p=0.018). Median creatinine level was higher in CSF patients ( 0.81 vs 0.72, p=0.015), HDL level was lower in CSF patients (39 vs. 43, p=0.033). Median iCEB values were significantly higher in the CSF group compared to the control group (4.18 vs. 4.07, p=0.006). In the analysis comparing single vessel CSF and multi vessel CSF patients, there was no difference between basal characteristic features and no statistically significant difference was found between iCEB values (4.18 vs. 4.15 p=0.391).
Conclusion: As a result of our study, the iCEB value was found to be significantly higher in CSF patients compared to the control group. However, no significant difference was found in terms of iCEB values in single-vessel CSF and multi-vessel CSF patients. The occurrence of increased iCEB in CSF may be associated with ventricular arrhythmias in this group of patients. Close monitoring of these parameters can be a guide in terms of predicting possible ventricular arrhythmias and demonstrating a more aggressive treatment approach in high-risk patients.

Anahtar Kelimeler

İndex of cardiac electrophysiological balance, coronary slow flow, ventricular arrhythmia

Kaynakça

• 1. Hawkins BM, Stavrakis S, Rousan TA, Abu-Fadel M, Schechter E. Coronary slow flow--prevalence and clinical correlations. Circ J. 2012;76(4):936-42.
• 2. Erturk M, Surgit O, Yalcin AA, et al. The evaluation of relationship between neutrophil tolymphocyte ratio and slow coronary flow. Dicle Med J 2013;40:537-42.
• 3. Beltrame JF, Limaye SB, Horowitz JD. The coronary slow flow phenomenon--a new coronary microvascular disorder. Cardiology. 2002;97(4):197-202.
• 4. Işık F, Aslan B, Çap M, Akyüz A, İnci Ü, Baysal E. The relationship between coronary slow-flow and frontal QRS-T angle. J Electrocardiol. 2021 May-Jun;66:43-47.
• 5. Robyns T, Lu HR, Gallacher DJ, et al. Evaluation of Index of Cardio-Electrophysiological Balance (iCEB) as a New Biomarker for the Identification of Patients at Increased Arrhythmic Risk. Ann Noninvasive Electrocardiol. 2016 May;21(3):294-304.
• 6. AskinL, Tanrıverdi O. Evaluation of index of cardio-electrophysiological balance in patients with coronary slow flow. ActaCardiol. 2022 Jun;77(4):337-341.
• 7. Xia S, Deng SB, Wang Y, et al. Clinical analysis of the risk factors of slow coronary flow. Heart Vessels. 2011 Sep;26(5):480-6
• 8. Tambe AA, Demany MA, Zimmerman HA, Mascarenhas E. Angina pectoris and slow flow velocity of dye in coronary arteries--a new angiographic finding. Am Heart J. 1972 Jul;84(1):66-71.
• 9. Gibson CM, Cannon CP, Daley WL, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996 Mar 1;93(5):879-88.
• 10. Sığırcı S, Sarıkaya R, Keskin K, et al. [Can biomarkers help us to understand the pathogenesis of coronary slow flow? Endocan and omentin-I in slow coronary flow phenomenon]. Turk Kardiyol DernArs. 2019 Jun;47(4):251-257. Turkish.
• 11. Cin VG, Pekdemir H, Camsar A, et al. Diffuse intimal thickening of coronary arteries in slow coronary flow. Jpn Heart J. 2003 Nov;44(6):907-19.
• 12. Saya S, Hennebry TA, Lozano P, Lazzara R, Schechter E. Coronary slow flow phenomenon and risk for sudden cardiac death due to ventricular arrhythmias: a case report and review of literature. Clin Cardiol. 2008 Aug;31(8):352-5.
• 13. Amasyali B, Turhan H, Kose S, et al. Aborted sudden cardiac death in a 20-year-old man with slow coronary flow. Int J Cardiol. 2006 May 24;109(3):427-9.
• 14. Chalikias G, Tziakas D. Slow Coronary Flow: Pathophysiology, Clinical Implications, andT herapeutic Management. Angiology. 2021 Oct;72(9):808-818.
• 15. Lu HR, Yan GX, Gallacher DJ. A new biomarker--index of cardiacelec trophysiological balance (iCEB)--plays an important role in drug-induced cardiac arrhythmias: beyond QT-prolongation and Torsades de Pointes (TdPs). J Pharmacol Toxicol Methods. 2013 Sep-Oct;68(2):250-259.