Turkiye Klinikleri Cardiovascular Sciences

.: ORIGINAL RESEARCH
Fragmented QRS: A New Independent Predictor of Mortality Factor in Chronic Kidney Disease Patients Who Have Coronary Artery Calcification: A Retrospective Cohort Study
Parçalanmış QRS: Koroner Arter Kalsifikasyonu Olan Kronik Böbrek Yetmezlikli Hastalarda Yeni Bir Bağımsız Mortalite Tahmini: Retrospektif Kohort Çalışması
Davut AZBOYa, Zeki TEMİZTÜRKa
aClinic of Cardiovascular Surgery, Elazığ Research and Training Hospital, Elazığ, TURKEY
Turkiye Klinikleri J Cardiovasc Sci. 2021;33(3):116-25
doi: 10.5336/cardiosci.2021-85734
Article Language: EN
Full Text
ABSTRACT
 Objective: Our aim of this study was to investigate the relationship between QRS fragmentation (fQRS) and clinical outcome in asymptomatic chronic kidney disease patients (CKDPs) with coronary artery calcification (CAC) score. Material and Methods: One-houndred-sixtyfour CKDPs were included. We used 64-slice multi-detector computed tomography (MDCT) for CAC score. We followed the patients for major adverse effect of cerebrovascular events (MACCE), requirement of coronary artery or cerebral or peripheral arterial revascularization. Results: Median CAC score was 744±443.2 Agatston unit (AU). In CKDPs with fQRS (n=55; Group 1), CAC score ≥300 AU. There was no evidence of fQRS in the remaining 109 patients (Group 2). Median CAC score was significantly higher than Group 2 patients (p=0.001). Eleven patients with higher CAC level required coronary artery revascularisation. Carotid artery stenosis, and peripheral artery occlusion were detected in Group 1 patients. In Group 2, we detected isolated coronary artery disease (CAD) in 12 (11%) patients. CAD, carotid and peripheral artery disease were more common in Group 1 (30% vs. 16.5%) (p=0.0001). Twenty two patients in Group 1, and 32 patients in Group 2 required coronary revascularisation within follow-up period (p=0.003). Fourteen patients in Group 1, and 18 patients in Group 2 died during follow-up period. Conclusion: Our study showed that there was a strong correlation between the frequency of fQRS and level of CAC score. To prevent MACCE in asymptomatic CKDPs who have fQRS, CAC score can be investigated by using MDCT.

Keywords: Fragmented QRS complex; computed tomography; coronary artery calcification; chronic kidney disease; cardiovascular events
ÖZET
 Amaç: Bu çalışmanın amacı, koroner arter kalsifikasyonu (KAK) skoru olan semptomsuz kronik böbrek yetmezlikli hastalarda (KBYH), parçalanmış QRS (pQRS) ile klinik sonuçları arasındaki ilişkiyi araştırmaktı. Gereç ve Yöntemler: Yüz altmış dört KBYH çalışmaya dâhil edildi. KAK skoru için 64 kesitli çok dedektörlü bilgisayarlı tomografi (ÇDBT) kullandık. Hastaları, majör kardiyak ve serebrovasküler olay (MKSVO) gelişmesi, koroner arter, serebral veya periferik arter revaskülarizasyonu gereksinimi açısından takip ettik. Bulgular: Medyan KAK skoru 744±443,2 Agatston birimi [Agatston unit (AU)] idi. KAK skoru pQRS'li KBYH'li hastalarda (n=55; Grup 1) ≥300 AU idi. Kalan 109 hastada (Grup 2) pQRS kanıtı yoktu. Medyan KAK skoru Grup 2 hastalarında anlamlı derecede yüksekti (p=0,001). Daha yüksek KAK düzeyine sahip 11 hastada koroner arter revaskülarizasyonu gerekti. Grup 1 hastalarda karotis arter stenozu ve periferik arter tıkanıklığı tespit edildi. Grup 2'de 12 (%11) hastada izole koroner arter hastalığı (KAH) saptadık. KAH, karotis ve periferik arter hastalığı Grup 1'de daha sıktı (%30'a karşı %16,5) (p=0,0001). Takip süresi içinde Grup 1'de 22, Grup 2'de 32 hastaya koroner revaskülarizasyon gerekti (p=0,003). İzlemde; Grup 1'de 14, Grup 2'de 18 hasta hayatını kaybetti. Sonuç: Çalışmamız, pQRS sıklığı ile KAK düzeyi arasında güçlü bir ilişki olduğunu göstermiştir. pQRS olan asemptomatik KBYH'lerde MKSVO'ları önlemek için MDBT kullanılarak KAK skoru araştırılabilir.

Anahtar Kelimeler: Parçalanmış QRS kompleksi; bilgisayarlı tomografi; koroner arter kalsifikasyonu; kronik böbrek hastalığı; kardiyovasküler olaylar
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