Research Article
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Obez hastalarda P dalga süresinin uzamasının asendan aort dilatasyonu ile ilişkisi

Year 2020, Volume: 17 Issue: 2, 283 - 288, 20.08.2020
https://doi.org/10.35440/hutfd.768880

Abstract

Amaç: Asendan aort dilatasyonu (AAD), akut aort sendromlarıyla yakından ilişkili olan ve erken bir aşamada tespit edilmezse ölümcül olabilen klinik bir antitedir. İnteratriyal blok (İAB) her iki atriyum arasında bir iletim gecikmesidir ve kardiyovasküler hastalıklar ile ilişkilidir. İAB'nin AAD'li obez hastalara eşlik edebileceğini ve asendan aort çapı ile P-dalga süresinin ilişkili olabileceğini düşündük. Bu nedenle, bu çalışmada obez hastalarda AAD ve İAB arasındaki ilişkiyi değerlendirdik.
Materyal ve metod: Rutin takip için polikliniğimize başvuran 318 ardışık obez hasta çalışmaya dahil edildi. Standart 12 derivasyonlu EKG’ler kaydedildi. Hastaların klinik özellikleri, ekokardiyografik verileri ve laboratuvar sonuçları kaydedildi.
Bulgular: Hastaların ortalama yaşı 62.7 ± 10.3 yıl idi ve hastaların 199'u (% 62.5) kadındı. İAB sıklığı ve uzamış P dalga süresi AAD (+) hastalarında AAD (-) gruba göre anlamlı olarak daha yüksekti (p <0.001 ve p < 0.001, sırasıyla). En güçlü korelasyon, asendan aort çapı ile P-dalga süresi arasında bulundu (r = 0.713, p <0.001). Lineer regresyon analizinde, P-dalga süresi (β = 0.695, p <0.001) ve sol atriyal volüm indeksi (LAVI) (β = 0.611, p = 0.005) asendan aort çapının bağımsız belirleyicileri olarak bulundu.
Sonuç: P-dalga süresinin uzamasının ve artmış LAVI değerlerinin asendan aort çapı ile anlamlı bir ilişkisinin olduğunu gösterdik. Bu nedenle, P dalgası süresinin AAD hastalarının takibinde kullanılabileceğini düşünüyoruz.

References

  • 1. Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE Jr, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines . J Am Coll Cardiol. 2010; 55: e27–e129.
  • 2. Akkuş O, Kaypaklı O, Koca H, Topuz M, Kaplan M, Baykan AO, et al. Thiol/disulphide homeostasis in thoracic aortic aneurysm and acute aortic syndrome. Biomark med. 2018; 12(4): 349-58.
  • 3. Dobrin PB, Baker WH, Gley WC. Elastolytic and collagenolytic studies of arteries. Implications for the mechanical properties of aneurysms. Arch Surg. 1984; 119: 405–09.
  • 4. Elefteriades JA. Natural history of thoracic aortic aneurysms: indications for surgery, and surgical versus nonsurgical risks. Ann Thorac Surg. 2002; 74: S1877–80.
  • 5. Dubick MA, Keen CL, DiSilvestro RA, Eskelson CD, Ireton J, Hunter GC. Antioxidant enzyme activity in human abdominal aortic aneurysmal and occlusive disease. Proc Soc Exp Biol Med. 1999; 220: 39–45.
  • 6. Brophy CM, Reilly JM, Smith GJ, Tilson MD. The role of inflammation in nonspecific abdominal aortic aneurysm disease. Ann Vasc Surg. 1991; 5: 229–33.
  • 7. Patel MI, Hardman DT, Fisher CM, Appleberg M. Current views on the pathogenesis of abdominal aortic aneurysms. J Am Coll Surg. 1995; 181: 371–82.
  • 8. Nemes A, Gavallér H, Csajbók E, Forster T, Csanády M. Obesity is associated with aortic enlargement and increased stiffness: an echocardiographic study. Int J Cardiovasc Imaging. 2008; 24(2): 165-71.
  • 9. Cuspidi C, Meani S, Fusi V, Valerio C, Sala C, Zanchetti A. Prevalence and correlates of aortic root dilatation in patients with essential hypertension: relationship with cardiac and extracardiac target organ damage. J Hypertens. 2006; 24(3): 573-80.
  • 10. Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol. 2009; 53(21): 1925-32.
  • 11. Owan T, Litwin SE. Is there a cardiomyopathy of obesity? Curr Heart Fail Rep. 2007; 4(4): 221-8.
  • 12. Abel ED, Litwin SE, Sweeney G. Cardiac remodeling in obesity. Physiol Rev. 2008; 88(2): 389-419.
  • 13. Poirier P, Cornier MA, Mazzone T, Stiles S, Cummings S, Klein S, et al. Bariatric surgery and cardiovascular risk factors: a scientific statement from the American Heart Association. Circulation. 2011; 123(15): 1683-701.
  • 14. Zalesin KC, Franklin BA, Miller WM, Peterson ED, McCullough PA. Impact of obesity on cardiovascular disease. Med Clin North Am. 2011; 95(5): 919-37.
  • 15. Bisbal F, Baranchuk A, Braunwald E, de Luna AB, Bayés-Genís A. Atrial failure as a clinical entity: JACC Review Topic of the Week. J Am Coll Cardiol. 2020; 75: 222–32.
  • 16. Bayés de Luna A, Platonov P, Cosio FG, Cygankiewicz I, Pastore C, Baranowski R, et al. Interatrial blocks. A separate entity from left atrial enlargement: a consensus report. J Electrocardiol. 2012; 45: 445–51.
  • 17. Bayés de Luna A, Oter MC, Guindo J. Interatrial conduction block with retrograde activation of the left atrium and paroxysmal supraventricular tachyarrhythmias: influence of preventive antiarrhythmic treatment. Int J Cardiol. 1989; 22: 147-50.
  • 18. Goyal SB, Spodick DH. Electromechanical dysfunction of the left atrium associated with interatrial block. Am Heart J. 2001; 142: 823-7.
  • 19. Lorbar M, Levrault R, Phadke JG, Spodick DH. Interatrial block as a predictor of embolic stroke. Am J Cardiol. 2005; 95: 667-8.
  • 20. Erbel R, AboyansV, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, et al. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014; 35(41): 2873–926.
  • 21. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. European Heart Journal-Cardiovascular Imaging. 2015; 16: 233-70.
  • 22. Stefano GT, Zhao H, Schluchter M, Hoit BD. Assessment of echocardiographic left atrial size: accuracy of M-mode and two-dimensional methods and prediction of diastolic dysfunction. Echocardiography. 2012; 29: 379–84.
  • 23. Abel ED, Litwin SE, Sweeney G. Cardiac remodeling in obesity. Physiol Rev. 2008; 88(2): 389-419.
  • 24. Martin SS, Qasim A, Reilly MP. Leptin resistance: a possible interface of inflammation and metabolism in obesity-related cardiovascular disease. J Am Coll Cardiol. 2008; 52(15): 1201-10.
  • 25. Schram K, Sweeney G. Implications of myocardial matrix remodeling by adipokines in obesity-related heart failure. Trends Cardiovasc Med. 2008; 18(6): 199-205.
  • 26. 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.
  • 27. Liu T, Fu Z, Korantzopoulos P, Zhang X, Wang S, Li G. Effect of obesity on p-wave parameters in a Chinese population. Ann Noninvasive Electrocardiol. 2010; 15(3): 259-63.
  • 28. Cetin M, Bozbeyoglu E, Erdogan T, Kocaman SA, Satiroglu O, Durakoglugil ME. Hair whitening and obesity are independently related to ascending aorta dilatation in young-middle aged men. North Clin Istanb. 2018; 6(1): 33-9.

The Association of The Prolongation Of P-Wave Duration With Ascending Aortic Dilatation In Obese Patients

Year 2020, Volume: 17 Issue: 2, 283 - 288, 20.08.2020
https://doi.org/10.35440/hutfd.768880

Abstract

Background: Ascending aortic dilatation (AAD) is a clinical entity, which is closely related to acute aortic syndromes and can be mortal if not detected at an early stage. Interatrial block (IAB) is a conduction delay between the both atriums, and is associated with cardiovascular diseases. We think that IAB may accompany with obese patients with AAD, and the diameter of ascending aorta may be correlated with P-wave duration. Thus, in the current study, we aimed to evaluate the association between AAD and IAB in obese patients.
Methods: A total of 318 consecutive obese subjects who were presented to our outpatient clinic for routine follow-up were enrolled into the study. Standard 12-lead ECGs were recorded. Clinical characteristics, echocardiographic data, and laboratory results of the patients were obtained.
Results: The mean age of the patients was 62.7 ± 10.3 years, and 199 (62.5%) of the patients were female. The frequency of IAB was significantly higher and P-wave duration was significantly increased in the AAD (+) patients than in the AAD (-) subjects (p < 0.001 and p < 0.001, respectively). The strongest correlation was found between ascending aortic diameter and P-wave duration (r = 0.713, p < 0.001). In linear regression analysis, P-wave duration (β = 0.695, p < 0.001) and left atrial volume index (LAVI) (β = 0.611, p = 0.005) were found to be independent predictors of ascending aortic diameter.
Conclusion: We demonstrated that prolongation of P-wave duration and increased LAVI values were significantly associated with ascending aortic diameter. Therefore, we think that P-wave duration may be used in the follow-up of the AAD patients.

References

  • 1. Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE Jr, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines . J Am Coll Cardiol. 2010; 55: e27–e129.
  • 2. Akkuş O, Kaypaklı O, Koca H, Topuz M, Kaplan M, Baykan AO, et al. Thiol/disulphide homeostasis in thoracic aortic aneurysm and acute aortic syndrome. Biomark med. 2018; 12(4): 349-58.
  • 3. Dobrin PB, Baker WH, Gley WC. Elastolytic and collagenolytic studies of arteries. Implications for the mechanical properties of aneurysms. Arch Surg. 1984; 119: 405–09.
  • 4. Elefteriades JA. Natural history of thoracic aortic aneurysms: indications for surgery, and surgical versus nonsurgical risks. Ann Thorac Surg. 2002; 74: S1877–80.
  • 5. Dubick MA, Keen CL, DiSilvestro RA, Eskelson CD, Ireton J, Hunter GC. Antioxidant enzyme activity in human abdominal aortic aneurysmal and occlusive disease. Proc Soc Exp Biol Med. 1999; 220: 39–45.
  • 6. Brophy CM, Reilly JM, Smith GJ, Tilson MD. The role of inflammation in nonspecific abdominal aortic aneurysm disease. Ann Vasc Surg. 1991; 5: 229–33.
  • 7. Patel MI, Hardman DT, Fisher CM, Appleberg M. Current views on the pathogenesis of abdominal aortic aneurysms. J Am Coll Surg. 1995; 181: 371–82.
  • 8. Nemes A, Gavallér H, Csajbók E, Forster T, Csanády M. Obesity is associated with aortic enlargement and increased stiffness: an echocardiographic study. Int J Cardiovasc Imaging. 2008; 24(2): 165-71.
  • 9. Cuspidi C, Meani S, Fusi V, Valerio C, Sala C, Zanchetti A. Prevalence and correlates of aortic root dilatation in patients with essential hypertension: relationship with cardiac and extracardiac target organ damage. J Hypertens. 2006; 24(3): 573-80.
  • 10. Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol. 2009; 53(21): 1925-32.
  • 11. Owan T, Litwin SE. Is there a cardiomyopathy of obesity? Curr Heart Fail Rep. 2007; 4(4): 221-8.
  • 12. Abel ED, Litwin SE, Sweeney G. Cardiac remodeling in obesity. Physiol Rev. 2008; 88(2): 389-419.
  • 13. Poirier P, Cornier MA, Mazzone T, Stiles S, Cummings S, Klein S, et al. Bariatric surgery and cardiovascular risk factors: a scientific statement from the American Heart Association. Circulation. 2011; 123(15): 1683-701.
  • 14. Zalesin KC, Franklin BA, Miller WM, Peterson ED, McCullough PA. Impact of obesity on cardiovascular disease. Med Clin North Am. 2011; 95(5): 919-37.
  • 15. Bisbal F, Baranchuk A, Braunwald E, de Luna AB, Bayés-Genís A. Atrial failure as a clinical entity: JACC Review Topic of the Week. J Am Coll Cardiol. 2020; 75: 222–32.
  • 16. Bayés de Luna A, Platonov P, Cosio FG, Cygankiewicz I, Pastore C, Baranowski R, et al. Interatrial blocks. A separate entity from left atrial enlargement: a consensus report. J Electrocardiol. 2012; 45: 445–51.
  • 17. Bayés de Luna A, Oter MC, Guindo J. Interatrial conduction block with retrograde activation of the left atrium and paroxysmal supraventricular tachyarrhythmias: influence of preventive antiarrhythmic treatment. Int J Cardiol. 1989; 22: 147-50.
  • 18. Goyal SB, Spodick DH. Electromechanical dysfunction of the left atrium associated with interatrial block. Am Heart J. 2001; 142: 823-7.
  • 19. Lorbar M, Levrault R, Phadke JG, Spodick DH. Interatrial block as a predictor of embolic stroke. Am J Cardiol. 2005; 95: 667-8.
  • 20. Erbel R, AboyansV, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, et al. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014; 35(41): 2873–926.
  • 21. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. European Heart Journal-Cardiovascular Imaging. 2015; 16: 233-70.
  • 22. Stefano GT, Zhao H, Schluchter M, Hoit BD. Assessment of echocardiographic left atrial size: accuracy of M-mode and two-dimensional methods and prediction of diastolic dysfunction. Echocardiography. 2012; 29: 379–84.
  • 23. Abel ED, Litwin SE, Sweeney G. Cardiac remodeling in obesity. Physiol Rev. 2008; 88(2): 389-419.
  • 24. Martin SS, Qasim A, Reilly MP. Leptin resistance: a possible interface of inflammation and metabolism in obesity-related cardiovascular disease. J Am Coll Cardiol. 2008; 52(15): 1201-10.
  • 25. Schram K, Sweeney G. Implications of myocardial matrix remodeling by adipokines in obesity-related heart failure. Trends Cardiovasc Med. 2008; 18(6): 199-205.
  • 26. 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.
  • 27. Liu T, Fu Z, Korantzopoulos P, Zhang X, Wang S, Li G. Effect of obesity on p-wave parameters in a Chinese population. Ann Noninvasive Electrocardiol. 2010; 15(3): 259-63.
  • 28. Cetin M, Bozbeyoglu E, Erdogan T, Kocaman SA, Satiroglu O, Durakoglugil ME. Hair whitening and obesity are independently related to ascending aorta dilatation in young-middle aged men. North Clin Istanb. 2018; 6(1): 33-9.
There are 28 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research Article
Authors

Mustafa Doğduş 0000-0002-3895-1923

İlhan Koyuncu 0000-0002-7594-0203

Mustafa Yenerçağ 0000-0002-0933-7852

Publication Date August 20, 2020
Submission Date July 13, 2020
Acceptance Date August 7, 2020
Published in Issue Year 2020 Volume: 17 Issue: 2

Cite

Vancouver Doğduş M, Koyuncu İ, Yenerçağ M. The Association of The Prolongation Of P-Wave Duration With Ascending Aortic Dilatation In Obese Patients. Harran Üniversitesi Tıp Fakültesi Dergisi. 2020;17(2):283-8.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty