EN | TR
E-ISSN: 1307-5608
The Role of Intrinsicoid Deflection Time in Precordial Leads Facing Right Ventricle and aVR for Diagnosis of Acute Pulmonary Thromboembolism and Determination Its Severity
PDF
Cite
Share
Request
Research Article
VOLUME: 71 ISSUE: 2
P: 135-140
August 2018

The Role of Intrinsicoid Deflection Time in Precordial Leads Facing Right Ventricle and aVR for Diagnosis of Acute Pulmonary Thromboembolism and Determination Its Severity

J Ankara Univ Fac Med 2018;71(2):135-140
DOI: 10.4274/atfm.44153
Orçun Çiftçi
Suzan Keskin
Kerem Can Yılmaz
Emir Karaçağlar
İbrahim Haldun Müderrisoğlu
1. Başkent Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Ankara, Türkiye
No information available.
No information available
Received Date: 07.01.2018
Accepted Date: 17.04.2018
Publish Date: 10.10.2018
PDF
Cite
Share
Request

ABSTRACT

Objectives:

Pulmonary thromboembolism (PTE) is associated with high morbidity and mortality. Recognition of massive and submassive PTE is important for management guidance. Intrinsicoid deflection time refers to the time from QRS onset to the peak of the R wave and corresponds to the spread of conduction from endocardium to epicardium. It has not been used for diagnosis and severity assessment of acute PTE. In this study the role of intrinsicoid deflection times (IDT) in the diagnosis and classification of prognosis of acute PTE.

Materials and Methods:

This study retrospectively included 89 patients who presented to Başkent University Hospital with symptoms compatible with PTE between January 2012 and January 2017. Thirty (33.7%) patients had no PTE, 30 (33.7%) had non-massive and 29 (32.6%) had massive PTE. Twenty (24.7%) patients had clinically mild PTE, 31 (34.8%) had submassive PTE, and 6 (6.7%) had massive PTE. IDT on V1, V2, and aVR of 12-lead electrocardiogram (ECG) were compared between those with and without PTE and between PTE severity groups. IDT on ECG was correlated with clinical, echocardiographic, and biochemical parameters.

Results:

Compared to PTE-negative subjects, IDT on lead V2 of ECG was significantly prolonged in PTE-positive patients, angiographically massive and non-massive PTE groups, and clinically massive and submassive groups. On correlation analyses, IDT on lead V2 was significantly correlated with the presence of PTE, angiographic and clinical severity, right ventricular systolic function, and right bundle branch block.

Conclusion:

Prolonged IDT on lead V2 is indicative of the presence of PTE, right ventricular dysfunction, and massive and submassive PTE. This parameter should be further studied in future large-scale prospective studies.

Keywords: Pulmonary Embolism, Electrocardiography, Intrinsicoid Deflection Time

References

1
Klok FA, van Kralingen KW, van Dijk AP, et al. Quality of Life in Long-term Survivors of Acute Pulmonary Embolism. Chest 2010;138:1432-1440.
2
Condliffe R, Kiely DG, Gibbs JS, et al. Prognostic and aetiological factors in chronic thromboembolic pulmonary hypertension. Eur Resp J 2009;33:332-338.
3
Gopalan D, Delcroix M, Held M. Diagnosis of chronic thromboembolic pulmonary hypertension. Eur Respir Rev 2017;26:143.
4
Laporte S, Mismetti P, Décousus H, et al. Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism: findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry. Circulation 2008;117:1711-1716.
5
Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014;35:3033-3069.
6
Pérez-Riera AR, de Abreu LC, Barbosa-Barros R, et al. R-Peak Time: An Electrocardiographic Parameter with Multiple Clinical Applications. Ann Noninvasive Electrocardiol 2016;21:10-19.
7
O’Neal WT, Qureshi WT, Nazarian S, et al. Electrocardiographic Time to Intrinsicoid Deflection and Heart Failure: The Multi-Ethnic Study of Atherosclerosis. Clin Cardiol 2016;39:531-536.
8
Darouian N, Narayanan K, Aro AL, et al. Delayed Intrinsicoid Deflection of the QRS Complex is Associated with Sudden Cardiac Arrest. Heart Rhytm 2016;13:927-932.
9
George A, Arumugham PS, Figueredo VM. aVR – the forgotten lead. Exp Clin Cardiol 2010;15:36-44.
10
Del-Carpio Munoz F, Powell BD, Cha YM, et al. Delayed intrinsicoid deflection onset in surface ECG lateral leads predicts left ventricular reverse remodeling after cardiac resynchronization therapy. Heart Rhythm 2013;10:979-987.
11
King JH, Huang CL, Fraser JA. Determinants of myocardial conduction velocity: implications for arrhythmogenesis. Front Physiol 2013;4:154.
12
De Groot JR, Coronel R. Acute ischemia- induced gap junctional uncoupling and arrhythmogenesis. Cardiovasc Res 2004;62:323-334.
13
Marcus JT, Gan CT, Zwanenburg JJ, et al. Interventricular Mechanical Asynchrony in Pulmonary Arterial Hypertension: Left-to-Right Delay in Peak Shortening Is Related to Right Ventricular Overload and Left Ventricular Underfilling. J Am Coll Cardiol 2008;51:750-757.
14
Vonk-Noordegraaf A, Marcus JT, Gan CT, et al. Interventricular mechanical asynchrony due to right ventricular pressure overload in pulmonary hypertension plays an important role in impaired left ventricular filling. Chest 2005;128(Suppl 6):628-630.
15
López-Candales A, Dohi K, Bazaz R, et al. Relation of right ventricular free wall mechanical delay to right ventricular dysfunction as determined by tissue Doppler imaging Am J Cardiol 2005;96:602-606.
2024 ©️ Galenos Publishing House