Turkiye Klinikleri Journal of Cardiology

.: ORIGINAL RESEARCH
Trombolitik Tedavinin Miyokard İnfarktüsü Sonrası Patolojik Q Dalga Gerilemesi Üzerine Etkisi
EFFECT OF THROMBOLYTIC THERAPY ON REGRESSIONOF ECG SIGNS OF MYOCARDIAL INFARCTION
Adnan ABACI*, Abdurrahman OĞUZHAN**, Abdullah DELİCEO***, Hüseyin ARINÇ***, Burhanettin KIRANATLI***, Namık Kemal ERYOL*, Ali ERGİN****
*, Erciyes Üniversitesi Tıp Fakültesi Kardiyoloji AD**, Erciyes Üniversitesi Tıp Fakültesi Kardiyoloji AD***, Erciyes Üniversitesi Tıp Fakültesi Kardiyoloji AD****, Erciyes Üniversitesi Tıp Fakültesi Kardiyoloji AD, KAYSERİ
Turkiye Klinikleri J Cardiol. 1999;12(1):7-12
Article Language: TR
Full Text
ÖZET
Akut miyokard infarktüsü (Mİ) sonrası patolojik Q dalgalarının gerilemesi önceden sanıldığı kadar nadir değildir. Retrospektif çalışmalar akut Mİ sonrası Q dalga gerileme sıklığının %5-15 arasında değiştiğini göstermiştir. Fakat, Q dalga gerilemesi ile akut Mİda trombolitik tedavi (TT) kullanımı arasındaki ilişki iyi bilinmemektedir. Bu çalışmanın amacı akut Mİ sonrası patolojik Q dalgalarının gerileme yaygınlığını değerlendirmek ve TTnin Q dalga gerilemesi üzerine etkisini araştırmaktır. Çalışma grubu akut Mİ tanısı ile koroner yoğun bakım ünitesine yatırılan hastalardan oluştu. EKGde eski Mİa bağlı Q dalga değişiklikleri olan veya akut Mİ nedeniyle daha önceden hastanede yatmış olan hastalara geçirilmiş Mİ tanısı kondu ve bu hastalar çalışmaya alınmadı. Çalışmaya toplam 538 hasta alındı. Q dalga gerilemesi patolojik, infarkt ile ilgili Q dalgalarının prekordiyal derivasyonlarda birden fazla ve ekstremite derivasyonlarında bir veya daha fazla derivasyonda kaybolması olarak tanımlandı. Ortalama 7.8 (1-60) aylık izlem sonrası 127 hasta (%23.6) Q dalgalarını kaybetti. Akut olay ile Q dalga kaybının görüldüğü ilk elektrokardiyogram arasındaki zaman farkı ortalama 4.6 ay idi. 538 hastadan 210u (%39) TT ile tedavi edilmişti ve Q dalga gerileme oranı, TT verilen hastalarda TT tedavisi uygulanmayan hastalardan anlamlı olarak daha yüksek idi (sırasıyla, 28.1% vs 20.7%, p=0.049). Pik CK ve CK MB değerleri, Q dalga kaybı görülmeyen hastalarda Q dalga kaybı görülen hastalara göre anlamlı olarak daha yüksek idi (sırasıyla, 1047±739, 145±74 ve 893±481, 123±59, P; 0.037 ve 0.004). Önemli darlık bulunan arter sayısı ile değerlendirilen koroner arter hastalığı ciddiyeti, iki grupta benzer idi (Q dalga kaybı olan grup; 2.1±1, Q dalga kaybı görülmeyen grup; 2.2±0.9, p =0.156). Ek olarak, Q dalga gerilemesi görülen hastalarda, ventrikül skorlama sistemi ile değerlendirilen sol ventrikül fonksiyonunun daha iyi olduğu bulundu (sırasıyla, 8.6±6.2 ve 10.9±5.9, p=0.003). Sonuç olarak, çalışma bulgularımız TT verilen hasta grubunda Q dalga gerilemesinin TT verilmeyen hasta grubundan anlamlı olarak daha yüksek olduğunu gösterdi. Q dalga kaybı görülen hastalardaki daha düşük pik CK ve CK MB bulgumuz, bu hastalarda infarkt alanının daha küçük olduğunu düşündürmektedir. TT verilen hastalardaki Q dalga gerileme fazlalığının altındaki neden, bu hastalarda infarkt alanının TT verilmeyen hastalara göre daha küçük olması olabilir.

Anahtar Kelimeler: Gerileme, Q-dalgası, Miyokard infarktüsü
ABSTRACT
Regression of pathologic Q waves after transmural acute myocardial infarction (MI) is not as unusual as previously suspected.Retrospective studies have shown that the prevalence of Q-wave regression after acute MI varies between 5% and 15%. But, the relationship between regression of Q waves and treatment of acute MI with thrombolytic therapy (TT) is not well known. Thus, the purposes of our study were to assess the extent of regression of pathologic Q-waves after acute MI, and to investigate the effect of TT on regression of Q-waves. Our study comprised consecutive patients (pts) with acute MI admitted to the coronary care unit. Previous infarction was diagnosed when either prior hospital admission for acute MI or electrocardiographic Q-wave abnormalities diagnostic of an old infarction was present, In conclusion, the results of our study show a significantly higher regression of Q-wave in the group of pts with TT than in the group of pts to whom TT was not given. The finding of a lower peak CK and CK MB values suggest a smaller infarct size in pts with lost Q waves. The reason behind the greater regression of Q wave in pts with TT may be related to a smaller infarct size in these pts compared to the pts without TT.and these pts were excluded from the study. The study included 538 pts in total. Q-wave regression was defined as disappearance of pathologic, infarct related Q-waves in >1 leads for precordial and ³1 for the extremity leads. After a mean follow up of 7.8 (1 to 60) months, 127 pts (23.6%) lost their Q waves. The mean time interval from the acute event to the first electrocardiogram showing Q-wave disappearance was 4.6 months. Of 538 pts, 210 (39%) were treated with TT, and regression rate of Q wave was significantly higher in pts who were given TT than in pts without TT treatment (28.1% vs. 20.7% respectively, p=0.049). Peak creatine kinase (CK) and CK MB values were significantly higher in pts who retained their Q waves than in those who lost them (1047±739, 145±74 vs. 893±481, 123±59, respectively, P; 0.037 and 0.004). Severity of coronary artery disease, as judged by the number of the significantly diseased arteries was similar in both groups (2.1±1 in pts who lost their Q wave vs. 2.2±0.9 in pts who retained their Q waves, p =0.156). In addition, it is found that pts showing Q-wave regression had better left ventricular function as assessed by the ventricular scoring system (8.6±6.2 vs. 10.9±5.9 respectively, p=0.003).

Keywords: regression, Q-wave, myocardial infarction

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