Araştırma Makalesi
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Evaluation of echocardiographic associates of interatrial block in patients with essential hypertension

Yıl 2020, Cilt: 2 Sayı: 3, 67 - 72, 29.10.2019

Öz

Objective: Myocardial fibrosis may cause conduction delays in hypertensive patients. Interatrial block (IAB), defined as a conduction delay between the right and left atrium, has been associated with cardiovascular events. In this study, we aimed to investigate the echocardiographic determinants of IAB in patients suffering from essential hypertension.

Materials and Methods: The population of this study included a total of 220 patients [male: 93 (42.3%), mean age: 61.8±7.8 years] with hypertension. IAB means a P wave duration of ≥120 ms on 12-lead electrocardiography recordings. Transthoracic echocardiography was used to evaluate all patients.

Results: IAB was revealed in 70 patients using electrocardiography. Both groups had similar demographic characteristics of the patients with and without IAB. There was a significant increase in interventricular septal thickness, posterior wall thickness, left atrial diameter (LAD), left ventricular mass, left ventricular mass index and the prevalence of left ventricular hypertrophy (LVH) among hypertensive patients with IAB. Independent predictors of IAB included increased LAD (OR=1.082; 95%CI: 1.006-1.164; p=0.034) and the presence of LVH (OR=3.051; 95%CI: 1.164-7.994; p=0.023). LAD values above 38 mm predicted IAB with a specificity of 58% and a sensitivity of 68% in the analyses of receiver operating characteristic curve (area under curve= 0.678; 95% confidence interval: 0.601-0.754; p<0.001).

Conclusion: There is a significant relationship between the presence of IAB and echocardiographic parameters related to LVH and left atrial dilatation among the patients suffering from essential hypertension. The IAB may be used as an electrocardiographic marker of myocardial fibrosis and cardiac remodeling among hypertensive patients.

Kaynakça

  • 1. Mills KT, Bundy JD, Kelly TN, et al. Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies From 90 Countries. Circulation. 2016;134(6):441-50.
  • 2. Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 1990;322:1561-6.
  • 3. Kahan T, Bergfeldt L. Left ventricular hypertrophy in hypertension: its arrhythmogenic potential. Heart 2005;91(2):250-6.
  • 4. Vogt M, Strauer BE. Systolic ventricular dysfunction and heart failure due to coronary microangiopathy in hypertensive heart disease. Am J Cardiol 1995;76:48D-53D.
  • 5. Chew DS, Wilton SB, Kavanagh K, et al. Fragmented QRS complexes after acute myocardial infarction are independently associated with unfavorable left ventricular remodeling. J Electrocardiol. 2018 ;51(4):607-612.
  • 6. Bayés de Luna A, Platonov P, Cosio FG, et al. Interatrial blocks. A separate entity from left atrial enlargement: A consensus report. J Electrocardiol 2012; 45:445-51.
  • 7. Conde D, Seoane L, Gysel M, Mitrione S, Bayés de Luna A, Baranchuk A. Bayés’ syndrome: the association between interatrial block and supraventricular arrhythmias. Expert Rev Cardiovasc Ther. 2015;13:541–550.
  • 8. Nielsen JB, Kühl JT, Pietersen A, et al. P-wave duration and the risk of atrial fibrillation: results from the Copenhagen ECG Study. Heart Rhythm. 2015;12:1887–1895.
  • 9. O’Neal WT, Zhang ZM, Loehr LR, Chen LY, Alonso A, Soliman EZ. Electrocardiographic advanced inter-atrial block and atrial fibrillation risk in the general population. Am J Cardiol. 2016;117:1755–1759.
  • 10. Martínez-Sellés M, Robledo LA, Baranchuk A. Interatrial block and the risk of ischemic stroke. J Atheroscler Thromb. 2017 ;24(2):185-186.
  • 11. O’Neal WT, Kamel H, Zhang ZM, Chen LY, Alonso A, Soliman EZ. Advanced interatrial block and ischemic stroke: the Atherosclerosis Risk in Communities Study. Neurology. 2016;87:352–356.
  • 12. Magnani JW, Gorodeski EZ, Johnson VM, et al. P wave duration is associated with cardiovascular and all-cause mortality outcomes: the National Health and Nutrition Examination Survey. Heart Rhythm 2011;8:93–100.
  • 13. Ariyarajah V, Kranis M, Apiyasawat S, Spodick DH. Potential factors that affect electrocardiographic progression of interatrial block. Annals of Noninvasive Electrocardiology. 2007;12(1):21-26.
  • 14. Pang H, Ronderos R, Pérez-Riera AR, Femenía F, Baranchuk A. Reverse atrial electrical remodeling: a systematic review. Cardiol J. 2011;18(6):625- 631.
  • 15. Bekar L, Katar M, Yetim M, Celik O, Kilci H, Onalan O. Fragmented QRS complexes are a marker of myocardial fibrosis in hypertensive heart disease. Turk Kardiyol Dern Ars. 2016;44(7):554-60.
  • 16. Drozdz D, Kawecka-Jaszcz K. Cardiovascular changes during chronic hypertensive states. Pediatr Nephrol. 2014;29(9):1507-16.
  • 17. Sun G, Zhou Y, Ye N, Wu S, Sun Y. Independent associations of blood pressure and body mass index with interatrial block: a cross-sectional study in general Chinese population. BMJ Open. 2019;9(7):e029463.
  • 18. Lovic D, Erdine S, Catakoğlu AB. How to estimate left ventricular hypertrophy in hypertensive patients. Anadolu Kardiyol Derg. 2014;14(4):389-95.
  • 19. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18(6):499-502.
  • 20. Zhou D, Xi B, Zhao M, Wang L, Veeranki SP. Uncontrolled hypertension increases risk of all-cause and cardiovascular disease mortality in US adults: the NHANES III Linked Mortality Study. Sci Rep. 2018;8(1):9418.
  • 21. Berk BC, Fujiwara K, Lehoux S. ECM remodeling in hypertensive heart disease. J Clin Invest. 2007; 117:568–575.
  • 22. Zhou D, Wang S, Tian T. Uncontrolled Hypertension and Risk of Cardiovascular Mortality in China. JAMA Intern Med. 2016;176(8):1233-4.
  • 23. Tsao CW, Gona PN, Salton CJ, et al. Left ventricular structure and risk of cardiovascular events: A Framingham Heart Study cardiac magnetic resonance study. J Am Heart Assoc. 2015;4: e002188.
  • 24. Burak C, Çağdaş M, Rencüzoğulları I, et al. Association of P wave peak time with left ventricular end-diastolic pressure in patients with hypertension. J Clin Hypertens (Greenwich). 2019 May;21(5):608-615.
  • 25. Boles U, Almuntaser I, Brown A, Murphy RR, Mahmud A, Feely J. Ventricular activation time as a marker for diastolic dysfunction in early hypertension. Am J Hypertens. 2010 Jul;23(7):781-5.
  • 26. Alexander B, Baranchuk A, Haseeb S, et al. Interatrial block predicts atrial fibrillation in patients with carotid and coronary artery disease. J Thorac Dis. 2018; 10:4328-4334.
  • 27. Çinier G, Tekkeşin AI, Genç D, et al. Interatrial block as a predictor of atrial fibrillation in patients with ST-segment elevation myocardial infarction. Clin Cardiol. 2018; 41: 1232-1237.

Esansiyel hipertansiyonu olan hastalarda interatriyal blok ile ilişkili ekokardiyografik bulguların değerlendirilmesi

Yıl 2020, Cilt: 2 Sayı: 3, 67 - 72, 29.10.2019

Öz

Amaç: Miyokardiyal fibrozis hipertansif hastalarda ileti gecikmelerine neden olabilir. Sağ ve sol atriyumlar arasında ileti gecikmesi olarak tanımlanan interatriyal blok (İAB) kardiyovasküler olaylarla ilişkilendirilmiştir. Bu çalışmada, esansiyel hipertansiyonu olan hastalarda İAB için ekokardiyografik belirleyicilerin araştırılması amaçlanmıştır.


Gereç ve Yöntemler:
Çalışma topluluğu toplam 220 hipertansif hastadan oluşturuldu [93 (%42,3) erkek, ortalama yaş 61,8±7,8 yıl]. İAB, 12 derivasyonlu EKG kaydında P dalgasının ≥120 msn olması olarak tanımlandı. Tüm hastalar transtorasik ekokardiyografi ile değerlendirildi.

Bulgular: İAB varlığı ekokardiyografi ile 70 hastada gösterildi. İAB olan ve olmayan hasta grupları benzer demografik özelliklere sahipti. İAB olan hipertansif hastalarda interventriküler septum kalınlığı, arka duvar kalınlığı, sol atriyum çapı, sol ventrikül kütlesi, sol ventrikül hipertrofisi (SVH) sıklığı ve sol ventrikül kütle indeksinde anlamlı artış saptandı. Artmış sol atriyum çapı (Rölatif Risk (RR)=1,082; %95 Güven Aralığı (GA): 1,006-1,164; p=0,034) ve SVH varlığı (RR=3,051; %95 GA: 1,164-7,994; p=0,023) İAB için bağımsız öngördürücüler olarak tespit edildi. ROC eğrisi analizinde 38 mm üzerindeki sol atriyum çapı değerleri İAB varlığını %58 özgüllük ve %68 duyarlılık ile öngörmektedir (Eğri altındaki alan = 0,678; %95 GA: 0,601-0,754; p<0,001).

Sonuç: Esansiyel hipertansiyonu olan hastalarda İAB varlığı ile SVH ve sol atriyum dilatasyonu ile ilgili ekokardiyografik parametreler arasında anlamlı bir ilişki bulunmaktadır. İAB, hipertansif hastalarda miyokardiyal fibrozis ve kardiyak yeniden modelleme için elektrokardiyografik bir belirteç olarak kullanılabilir.

Kaynakça

  • 1. Mills KT, Bundy JD, Kelly TN, et al. Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies From 90 Countries. Circulation. 2016;134(6):441-50.
  • 2. Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 1990;322:1561-6.
  • 3. Kahan T, Bergfeldt L. Left ventricular hypertrophy in hypertension: its arrhythmogenic potential. Heart 2005;91(2):250-6.
  • 4. Vogt M, Strauer BE. Systolic ventricular dysfunction and heart failure due to coronary microangiopathy in hypertensive heart disease. Am J Cardiol 1995;76:48D-53D.
  • 5. Chew DS, Wilton SB, Kavanagh K, et al. Fragmented QRS complexes after acute myocardial infarction are independently associated with unfavorable left ventricular remodeling. J Electrocardiol. 2018 ;51(4):607-612.
  • 6. Bayés de Luna A, Platonov P, Cosio FG, et al. Interatrial blocks. A separate entity from left atrial enlargement: A consensus report. J Electrocardiol 2012; 45:445-51.
  • 7. Conde D, Seoane L, Gysel M, Mitrione S, Bayés de Luna A, Baranchuk A. Bayés’ syndrome: the association between interatrial block and supraventricular arrhythmias. Expert Rev Cardiovasc Ther. 2015;13:541–550.
  • 8. Nielsen JB, Kühl JT, Pietersen A, et al. P-wave duration and the risk of atrial fibrillation: results from the Copenhagen ECG Study. Heart Rhythm. 2015;12:1887–1895.
  • 9. O’Neal WT, Zhang ZM, Loehr LR, Chen LY, Alonso A, Soliman EZ. Electrocardiographic advanced inter-atrial block and atrial fibrillation risk in the general population. Am J Cardiol. 2016;117:1755–1759.
  • 10. Martínez-Sellés M, Robledo LA, Baranchuk A. Interatrial block and the risk of ischemic stroke. J Atheroscler Thromb. 2017 ;24(2):185-186.
  • 11. O’Neal WT, Kamel H, Zhang ZM, Chen LY, Alonso A, Soliman EZ. Advanced interatrial block and ischemic stroke: the Atherosclerosis Risk in Communities Study. Neurology. 2016;87:352–356.
  • 12. Magnani JW, Gorodeski EZ, Johnson VM, et al. P wave duration is associated with cardiovascular and all-cause mortality outcomes: the National Health and Nutrition Examination Survey. Heart Rhythm 2011;8:93–100.
  • 13. Ariyarajah V, Kranis M, Apiyasawat S, Spodick DH. Potential factors that affect electrocardiographic progression of interatrial block. Annals of Noninvasive Electrocardiology. 2007;12(1):21-26.
  • 14. Pang H, Ronderos R, Pérez-Riera AR, Femenía F, Baranchuk A. Reverse atrial electrical remodeling: a systematic review. Cardiol J. 2011;18(6):625- 631.
  • 15. Bekar L, Katar M, Yetim M, Celik O, Kilci H, Onalan O. Fragmented QRS complexes are a marker of myocardial fibrosis in hypertensive heart disease. Turk Kardiyol Dern Ars. 2016;44(7):554-60.
  • 16. Drozdz D, Kawecka-Jaszcz K. Cardiovascular changes during chronic hypertensive states. Pediatr Nephrol. 2014;29(9):1507-16.
  • 17. Sun G, Zhou Y, Ye N, Wu S, Sun Y. Independent associations of blood pressure and body mass index with interatrial block: a cross-sectional study in general Chinese population. BMJ Open. 2019;9(7):e029463.
  • 18. Lovic D, Erdine S, Catakoğlu AB. How to estimate left ventricular hypertrophy in hypertensive patients. Anadolu Kardiyol Derg. 2014;14(4):389-95.
  • 19. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18(6):499-502.
  • 20. Zhou D, Xi B, Zhao M, Wang L, Veeranki SP. Uncontrolled hypertension increases risk of all-cause and cardiovascular disease mortality in US adults: the NHANES III Linked Mortality Study. Sci Rep. 2018;8(1):9418.
  • 21. Berk BC, Fujiwara K, Lehoux S. ECM remodeling in hypertensive heart disease. J Clin Invest. 2007; 117:568–575.
  • 22. Zhou D, Wang S, Tian T. Uncontrolled Hypertension and Risk of Cardiovascular Mortality in China. JAMA Intern Med. 2016;176(8):1233-4.
  • 23. Tsao CW, Gona PN, Salton CJ, et al. Left ventricular structure and risk of cardiovascular events: A Framingham Heart Study cardiac magnetic resonance study. J Am Heart Assoc. 2015;4: e002188.
  • 24. Burak C, Çağdaş M, Rencüzoğulları I, et al. Association of P wave peak time with left ventricular end-diastolic pressure in patients with hypertension. J Clin Hypertens (Greenwich). 2019 May;21(5):608-615.
  • 25. Boles U, Almuntaser I, Brown A, Murphy RR, Mahmud A, Feely J. Ventricular activation time as a marker for diastolic dysfunction in early hypertension. Am J Hypertens. 2010 Jul;23(7):781-5.
  • 26. Alexander B, Baranchuk A, Haseeb S, et al. Interatrial block predicts atrial fibrillation in patients with carotid and coronary artery disease. J Thorac Dis. 2018; 10:4328-4334.
  • 27. Çinier G, Tekkeşin AI, Genç D, et al. Interatrial block as a predictor of atrial fibrillation in patients with ST-segment elevation myocardial infarction. Clin Cardiol. 2018; 41: 1232-1237.
Toplam 27 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Araştırma Makaleleri
Yazarlar

Mucahit Yetim Bu kişi benim 0000-0002-2444-7523

Macit Kalçık 0000-0002-8791-4475

Lütfü Bekar Bu kişi benim 0000-0002-3920-1382

Osman Karaarslan Bu kişi benim 0000-0002-2412-0985

Muhammet Çelik Bu kişi benim 0000-0002-6496-7849

İsmail Ekinözü Bu kişi benim 0000-0002-9016-9103

Mehmet Yılmaz Bu kişi benim 0000-0002-8604-0972

Teyyar Gökdeniz Bu kişi benim 0000-0001-5345-2359

Yusuf Karavelioğlu 0000-0002-2544-1975

Yayımlanma Tarihi 29 Ekim 2019
Gönderilme Tarihi 6 Ekim 2020
Kabul Tarihi 24 Ekim 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 2 Sayı: 3

Kaynak Göster

AMA Yetim M, Kalçık M, Bekar L, Karaarslan O, Çelik M, Ekinözü İ, Yılmaz M, Gökdeniz T, Karavelioğlu Y. Esansiyel hipertansiyonu olan hastalarda interatriyal blok ile ilişkili ekokardiyografik bulguların değerlendirilmesi. Hitit Medical Journal. Ekim 2019;2(3):67-72.