Kosuyolu Heart J 2010;13(1)
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QRS Fragmentation is Associated with Functional Mitral Regurgitation and Papillary Muscle
Dyssynchrony in Patients with Non-ischemic Dilated Cardiomyopathy and Sinus Rhythm

Kursat Tigen MD1, Tansu Karaahmet MD1, Emre Gurel MD1, Selcuk Pala MD1,
Cihan Dundar MD1, Mustafa Akcakoyun MD1, Cihan Cevik MD2, Ozcan Basaran MD1,
Yelda Basaran MD1


1 Kartal Kosuyolu Heart Education and Research Hospital, Cardiology Division, Istanbul, Turkey

2 Texas Tech University Health Sciences Center, Department of Internal Medicine, Lubbock, TX

ABSTRACT

Aim: We investigated the impact of fragmented QRS (fQRS) complexes on ECG in predicting papillary muscle dyssynchrony and functional mitral regurgitation in patients with non-ischemic dilated cardiomyopathy with narrow QRS and sinus rhythm.

Methods: Thirty-one non-ischemic dilated cardiomyopathy patients with fQRS and 16 patients without fQRS were evaluated for intraventricular and papillary muscle dyssynchrony. All patients were in sinus rhythm and having narrow QRS intervals. Maximal Ts (duration between the beginning of the QRS complex and myocardial peak systolic velocity), difference between basal septal and lateral myocardial segments (ASE Sep-Lat Sys) and anterolateral and posteromedial papillary muscles (ASE Inter PAP Sys) were calculated to assess synchronicity.

Results: The patients with fQRS had significantly higher mitral regurgitant volume (p=0.043), shorter E wave deceleration (p=0.01) and isovolumetric relaxation time (p=0.044), lower basal septal (p=0.033) and lower basal lateral (p=0.007) TDI peak systolic velocities and higher ASE Sep-Lat Sys (p=0.041) and ASE Inter PAP Sys (p=0.033) values than patients without fQRS complexes.

Conclusion: fQRS was associated with intraventricular and papillary muscle dysssynchrony and more severe functional mitral regurgitation in patients with non-ischemic dilated cardiomyopathy and sinus rhythm. The presence of fQRS complexes may be useful in selecting patients for cardiac resynchronization therapy.

Key Words: Mitral stenosis, mitral balloon valvuloplasty, left ventricular function, tissue Doppler Imaging

Sinüs Ritmindeki Non-iskemik Dilate Kardiyomiyopatili Hastalarda EKG'de Fragmante
QRS Varlığı Papiller Kas Dissenkronisi ve Fonksiyonel Mitral Yetersizliği ile İlişkilidir

QRS Fragmentation is Associated with Functional Mitral Regurgitation and Papillary Muscle
Dyssynchrony in Patients with Non-ischemic Dilated Cardiomyopathy and Sinus Rhythm

Kursat Tigen MD1, Tansu Karaahmet MD1, Emre Gurel MD1, Selcuk Pala MD1,
Cihan Dundar MD1, Mustafa Akcakoyun MD1, Cihan Cevik MD2, Ozcan Basaran MD1,
Yelda Basaran MD1


1 Kartal Kosuyolu Heart Education and Research Hospital, Cardiology Division, Istanbul, Turkey

2 Texas Tech University Health Sciences Center, Department of Internal Medicine, Lubbock, TX

ÖZET

Amaç: Çalışmamızda dar qrs'li non-iskemik dilate kardiyomiyopatili hastalarda ekg'de fragmante qrs varlığının fonksiyonel mitral yetersizliği ve papiller kas asenkroni ile ilişkisi incelendi.

Metodoloji: Sol ventrikül ejeksiyon fraksiyonu < %40 olan sinüs ritmindeki dar (<120msn) fragmante qrs'li 31 hasta ve bazal ekg'sinde fragmantasyon olmayan 16 dar qrs'li non-iskemik dilate kardiyomiyopatili hasta prospektif olarak çalışmaya dahil edildi. Senkronisite incelemesi için sol ventrikül bazal septal ve lateral segmentlerinin Ts (qrs kompleksinin başlangıcı referans noktası olarak alınarak miyokardiyal pik sistolik velositeye kadar geçen süre) değerleri arasındaki maksimal fark (ASE Sep-Lat Sys) ve anterolateral ve posteromedial papiller kasların Ts değerleri arasındaki maksimal fark (ASE Inter PAP Sys) hesaplandı. Fonksiyonel mitral yetersizliğinin derecesi PISA metodu ile değerlendirildi.

Bulgular: İstirahat ekg'sinde fargmantasyon olan hastaların mitral kaçak hacimleri anlamlı olarak yüksek (p=0.043), E dalga deselerasyon zamaları (p=0.01) ve izovolumetrik relaksasyon zamanları (p=0.044) anlamlı olarak kısa, bazal septum (p=0.033) ve bazal lateral (p=0.07) TDI pik sistolik velositeleri anlamlı olarak düşük, ASE Sep-Lat Sys (p=0.041) ve ASE Inter PAP Sys (p=0.033) anlamlı şekilde yüksek bulundu.

Sonuç: Sinüs ritmindeki dar qrs'li non-iskemik dilate kardiyomiyopatili hastalarda bazal ekg'de fragmantasyon varlığı, intraventriküler ve papiller kas asenkronisi ve yüksek fonksiyonel mitral yetersizliği kaçak volümü ile ilişkilidir. Ekg'de fragmantasyon varlığı kardiyak resenkronizasyon tedavisinden fayda görebilecek, intraventriküler ve papiller kas asenkronisi yönünden araştırılması gereken dar qrs'li non-iskemik dilate kardiyomiyopatili hastaların belirlenmesinde önemli bir parametredir.

Anahtar Kelimeler: Kardiyomiyopati, dissenkroni, fragmante QRS

ABSTRACT

Aim: We investigated the impact of fragmented QRS (fQRS) complexes on ECG in predicting papillary muscle dyssynchrony and functional mitral regurgitation in patients with non-ischemic dilated cardiomyopathy with narrow QRS and sinus rhythm.

Methods: Thirty-one non-ischemic dilated cardiomyopathy patients with fQRS and 16 patients without fQRS were evaluated for intraventricular and papillary muscle dyssynchrony. All patients were in sinus rhythm and having narrow QRS intervals. Maximal Ts (duration between the beginning of the QRS complex and myocardial peak systolic velocity), difference between basal septal and lateral myocardial segments (ASE Sep-Lat Sys) and anterolateral and posteromedial papillary muscles (ASE Inter PAP Sys) were calculated to assess synchronicity.

Results: The patients with fQRS had significantly higher mitral regurgitant volume (p=0.043), shorter E wave deceleration (p=0.01) and isovolumetric relaxation time (p=0.044), lower basal septal (p=0.033) and lower basal lateral (p=0.007) TDI peak systolic velocities and higher ASE Sep-Lat Sys (p=0.041) and ASE Inter PAP Sys (p=0.033) values than patients without fQRS complexes.

Conclusion: fQRS was associated with intraventricular and papillary muscle dysssynchrony and more severe functional mitral regurgitation in patients with non-ischemic dilated cardiomyopathy and sinus rhythm. The presence of fQRS complexes may be useful in selecting patients for cardiac resynchronization therapy.

Key Words: Mitral stenosis, mitral balloon valvuloplasty, left ventricular function, tissue Doppler Imaging

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