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Kapıcı OB, Abuş S, Ayhan S, Koparal M, Kaya H. Comparison of frontal QRS-T angle of patients with nasal septal deviation with healthy controls. BMC Cardiovasc Disord 2023; 23:415. [PMID: 37612611 PMCID: PMC10464060 DOI: 10.1186/s12872-023-03421-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/30/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND This study compares frontal QRS-T angle (fQRS-T) in electrocardiogram (ECG) examinations of people with nasal septal deviation (NSD) with healthy controls (HC). METHODS Eighty-two patients whom a radiologist with paranasal computed tomography definitively diagnosed with NSD were included in the study. 101 individuals without NSD were selected as HC. RESULTS Compared to the HC group, the fQRS-T in was considerably wider in patients with NSD (p < .001). According to Spearman correlation analysis, fQRS-T and NSD angle, and platelet lymphocyte ratio (PLR) were significantly correlated (p = .021, p < .001, and p = .003, respectively). In linear regression analysis where the fQRS-T was taken as a dependent variable, NSD angle and PLR predicted the fQRS-T significantly and positively (F(5.76) = 8.451, R2 = 0.357, Adjusted R2 = 0.315 and p < .001). CONCLUSION In this study, fQRS-T was significantly higher in patients with NSD. In future studies, fQRS-T can be compared before and after septoplasty in NSD patients.
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Affiliation(s)
- Olga Bayar Kapıcı
- Department of Radiology, Adiyaman University Education and Research Hospital, Adiyaman, Turkey.
| | - Sabri Abuş
- Department of Cardiology, Adiyaman University Education and Research Hospital, Adiyaman, Turkey
| | - Selçuk Ayhan
- Department of Cardiology, Adiyaman University Education and Research Hospital, Adiyaman, Turkey
| | - Mehtap Koparal
- Department of Otorhinolaryngology, Adiyaman University Education and Research Hospital, Adiyaman, Turkey
| | - Hakan Kaya
- Department of Cardiology, Adiyaman University Education and Research Hospital, Adiyaman, Turkey
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Shin GC, Kang JW, Park JH, Lee HC, Kim KS. Changes in Subjective Outcomes during the Early Period after Septoturbinoplasty. Yonsei Med J 2023; 64:42-47. [PMID: 36579378 PMCID: PMC9826964 DOI: 10.3349/ymj.2022.0405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Septoturbinoplasty is frequently performed to correct nasal obstruction; however, there is still a lack of research on changes in nasal and nose-related symptoms early after septoturbinoplasty. Therefore, we aimed to investigate changes in subjective outcomes within 6 months after septoturbinoplasty. MATERIALS AND METHODS The medical records of patients who underwent septoturbinoplasty at Gangnam Severance Hospital were retrospectively analyzed. Symptom scores were evaluated using the Sino-nasal Outcome Test (SNOT-22) and obstruction scores. The SNOT-22 and obstruction scores were investigated before surgery and at 1, 3, and 6 months after surgery. RESULTS We noted significant decreases in both SNOT-22 and obstruction scores at 1 month after surgery, compared to those before surgery (p<0.001). However, there were no significant changes at 3 and 6 months after surgery, compared to scores at 1 month after surgery. Using multivariate logistic regression analysis, a larger difference between SNOT-22 scores preoperatively and 1 month after surgery was significantly associated with a significant improvement in symptoms at 3 or 6 months after septoturbinoplasty (p=0.029). CONCLUSION These results imply that subjective outcomes and degree of improvement in the first month after septoturbinoplasty can be used as a predictor of the results thereof and for counseling patients about its progress.
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Affiliation(s)
- Geun Cheol Shin
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ju Wan Kang
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ju Ha Park
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Han Cheol Lee
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung-Su Kim
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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The Impact of Septoplasty on Cardiopulmonary Functions in Patients With Nasal Septal Deviation: A Prospective Comprehensive Analysis of Echocardiographic Outcome and Serum N-Terminal Pro BNP Levels. J Craniofac Surg 2021; 33:35-40. [PMID: 34267121 DOI: 10.1097/scs.0000000000007801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT This study was designed to evaluate the impact of septoplasty on cardiopulmonary functions in patients with nasal septal deviation (NSD). A total of 30 consecutive adult patients (mean [standard deviation] age: 33.7 [10.9] years, 56.7% were males) who underwent septoplasty due NSD were included. Visual analog scale scores, nose obstruction symptom evaluation scale scores, serum N-terminal Pro BNP levels, and cardiologic examination findings on electrocardiogram, transthoracic echocardiography, and exercise treadmill testing were evaluated both 7 days before and 3-months after septoplasty operation. A significant decrease was noted in mean (standard deviation) visual analog scale scores (8.27 [0.83] versus 1.87 [0.73], P < 0.001), and nose obstruction symptom evaluation scores (83.7 [4.9] versus 12.7 [(5.4], P < 0.001) from preoperative to postoperative period, while maximum effort capacity was improved significantly (11.8 [1.9] versus 13.1 [2.1], P = 0.010) after septoplasty. Echocardiography findings at 3rd postoperative month revealed significant decrease in pulmonary artery systolic pressure (22.2 [3.2] versus 19.0 [3.6], P = 0.001), whereas significant increase in trans-mitral early diastolic rapid filling (E wave, 0.82 [0.14] versus 0.87 [0.13], P = 0.011), peak systolic velocity (S, 0.11 [0.02] versus 0.12 [0.02], P = 0.002), tricuspid annular plane systolic excursion (22.6 [3.2] versus 24.9 [2.9], P = 0.002), and right ventricle stroke volume (0.14 [(0.02] versus 0.15 [0.02], P = 0.013). In conclusion, our findings indicate favorable outcome of septoplasty in NSD patients not only in terms of improved nasal airflow but also cardiopulmonary functions, particularly the exercise capacity, pulmonary artery pressure, and right ventricular systolic functions. In this regard, our findings emphasize the important role of treating NSD patients without delay, given the likelihood of septoplasty to reverse the changes in the pulmonary artery system and to prevent onset of permanent cardiopulmonary dysfunction via amelioration of chronic obstruction of the upper respiratory tract.
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Kang XR, Chen B, Chen YS, Yi B, Yan X, Jiang C, Wang S, Lu L, Shi R. A prediction modeling based on SNOT-22 score for endoscopic nasal septoplasty: a retrospective study. PeerJ 2020; 8:e9890. [PMID: 32974101 PMCID: PMC7489239 DOI: 10.7717/peerj.9890] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/17/2020] [Indexed: 12/15/2022] Open
Abstract
Background To create a nomogram prediction model for the efficacy of endoscopic nasal septoplasty, and the likelihood of patient benefiting from the operation. Methods A retrospective analysis of 155 patients with nasal septum deviation (NSD) was performed to develop a predictive model for the efficacy of endoscopic nasal septoplasty. Quality of life (QoL) data was collected before and after surgery using Sinonasal Outcome Test-22 (SNOT-22) scores to evaluate the surgical outcome. An effective surgical outcome was defined as a SNOT-22 score change ≥ 9 points after surgery. Multivariate logistic regression analysis was then used to establish a predictive model for the NSD treatment. The predictive quality and clinical utility of the predictive model were assessed by C-index, calibration plots, and decision curve analysis. Results The identified risk factors for inclusion in the predictive model were included. The model had a good predictive power, with a AUC of 0.920 in the training group and a C index of 0.911 in the overall sample. Decision curve analysis revealed that the prediction model had a good clinical applicability. Conclusions Our prediction model is efficient in predicting the efficacy of endoscopic surgery for NSD through evaluation of factors including: history of nasal surgery, preoperative SNOT-22 score, sinusitis, middle turbinate plasty, BMI, smoking, follow-up time, seasonal allergies, and advanced age. Therefore, it can be cost-effective for individualized preoperative assessment.
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Affiliation(s)
- Xue-Ran Kang
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, China
| | - Bin Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, China
| | - Yi-Sheng Chen
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Yi
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, China
| | - Xiaojun Yan
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, China
| | - Chenyan Jiang
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, China
| | - Shulun Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, China
| | - Lixing Lu
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, China
| | - Runjie Shi
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, China
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Effects of Septoplasty on Tp-e Interval and Tp-e/QT Ratio in Patients With Nasal Septal Deviation. J Craniofac Surg 2020; 31:91-94. [PMID: 31469741 DOI: 10.1097/scs.0000000000005890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES There are multiple nasal airway pathologies leading to upper airway obstruction, and one of the most common ones is nasal septum deviation (NSD). Our study aimed to evaluate the effect of nasal septal surgery in patients with NSD on ventricular arrhythmogenesis using the novel electrocardiographic parameters, Tp-e interval, and Tp-e/QT ratio. METHODS This retrospective cross-sectional study included 102 consecutive patients diagnosed with NSD. All participants completed a validated outcomes instrument (the NOSE scale), echocardiographic and electrocardiographic evaluation before and 3 months after septoplasty. The degree of nasal septal deviation was evaluated with the Dreher classification. RESULTS All of the electrocardiography parameters (except heart rate and QTmin) were significantly decreased with the septoplasty operation. Electrocardiographic parameters have significantly decreased especially in marked NSD patients. (Δ = difference between the preoperative and postoperative values) ΔNOSE was positively correlated both ΔcTp-e (r = 0.348, P < .001) and ΔcTp-e/QT values (r = 0.536, P < .001). CONCLUSION Consequently, marked NSD was associated with increased risk of arrhythmogenesis, which were too much improved after septoplasty. So, treatment of especially marked NSD not only reduces otolaryngological complaints, but also leads to improvement of ventricular repolarization parameters.
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Üstün Bezgin S, Çakabay T, Bayramoğlu SE, Sayın N, Koçyiğit M. Evaluation of choroidal thickness measurements in patients with marked nasal septal deviation. Braz J Otorhinolaryngol 2020; 86:242-246. [PMID: 30683564 PMCID: PMC9422583 DOI: 10.1016/j.bjorl.2018.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/22/2018] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Chronic upper airway obstruction due to marked nasal septal deviation may cause chronic hypoxia. It may change the balance of the sympathetic-parasympathetic system and may affect blood flow in the choroid. OBJECTIVE To assess choroidal thickness measurements of patients with marked nasal septal deviation. METHODS The patients who had nasal obstruction symptoms diagnosed with marked nasal septal deviation by anterior rhinoscopy and nasal endoscopy and scheduled for septoplasty were included in the study. The control group consisted of age, sex and body mass index-matched healthy individuals. The choroidal measurements at the central fovea and 1000μm away from the fovea in the nasal and temporal regions were performed using enhanced depth imaging optical coherence tomography. RESULTS In the study group, 52 eyes of 26 patients with a mean age of 26.34±8.14 years were examined. In the control group, 52 eyes of 28 healthy individuals with a mean age of 26.69±7.84 years were examined. There was no statistically significant difference in terms of choroidal thickness measurements between the groups (p>0.05). CONCLUSION Our results suggest that marked nasal septal deviation may not lead to significant hypoxia and sympathetic activation, resulting in deterioration of the choroidal blood flow and consequent choroidal thickening.
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Affiliation(s)
- Selin Üstün Bezgin
- Istanbul Kanuni Sultan Süleyman Training and Research Hospital, Department of Otorhinolaryngology, Istanbul, Turkey.
| | - Taliye Çakabay
- Istanbul Kanuni Sultan Süleyman Training and Research Hospital, Department of Otorhinolaryngology, Istanbul, Turkey
| | - Sadık Etka Bayramoğlu
- Istanbul Kanuni Sultan Süleyman Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey
| | - Nihat Sayın
- Istanbul Kanuni Sultan Süleyman Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey
| | - Murat Koçyiğit
- Istanbul Kanuni Sultan Süleyman Training and Research Hospital, Department of Otorhinolaryngology, Istanbul, Turkey
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Evaluation of Heart Functions With Detailed Echocardiogram in Patients With Septum Deviation. J Craniofac Surg 2019; 29:2148-2152. [PMID: 30028402 DOI: 10.1097/scs.0000000000004742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND One of the most important reasons for nasal congestion is septum deviation. Nasal septal deviation increases airway resistance and can cause systemic problems. In this study, echocardiographic findings were compared with the normal population to see how cardiac function was affected in patients with obstructive nasal septum deviation. METHODS This study included a young patient group with 44 obstructive septum deviation patients and 30 healthy individuals with no nasal-related problems. Echocardiography was performed by the same cardiologist and results were compared with normal patients. The authors got permission from the ethics committee of faculty for the study (E. 116795). RESULTS In the patient group with septum deviation, pulmonary artery pressure was high. In addition, the size of the right heart chambers was also increased. TAPSE, pulmonary acceleration time, ejection fraction, and right ventricular outflow tract-fractional shortening were found to be lower than the normal group. CONCLUSION Patients with obstructive septum deviations should be evaluated early for cardiologic functions.
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Effect of Septoplasty on the Heart Rate Variability in Patients With Nasal Septum Deviation. J Craniofac Surg 2018; 29:445-448. [PMID: 29509172 DOI: 10.1097/scs.0000000000004149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Nasal septum deformities (NSD) are one of the most common causes of upper airway obstruction. Heart rate variability (HRV) is a physiologic parameter that is affected by the balance between the sympathetic and parasympathetic tonus. OBJECTIVE The aim of this study was to evaluate the effects of a septoplasty operation on HRV parameters as assessed by 24 hours ambulatory Holter recordings in patients with NSD. METHODS The prospective study involved 54 consecutive patients (16 women and 38 men) who underwent septoplasty due to a marked C- or S-shaped NSD. Twenty-four-hour Holter monitoring was performed to all patients pre- and 2 months postseptoplasty operation. For the HRV analyses, the definitions of evaluated parameters were made according to the Task Force of European Society of Cardiology and the North American Society of Pacing and Electrophysiology on HRV. RESULTS Low-frequency norm () (73 [68-86] versus 78 [70-81], P = 0.039) values were significantly increased after septoplasty whereas changes in other parameters were not statistically significant. CONCLUSION The authors' study showed that low-frequency norm values were significantly increased after septoplasty operation in patients with NSD which may be interpreted as a decreased sympathetic tone.
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Does Nasal Surgery Affect Right Ventricular Myocardial Functions at the Tissue Level in Patients with Nasal Septum Deviation? J Clin Med 2018; 7:jcm7080186. [PMID: 30060456 PMCID: PMC6112028 DOI: 10.3390/jcm7080186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/18/2018] [Accepted: 07/23/2018] [Indexed: 01/20/2023] Open
Abstract
Objective: One of the most common causes of upper airway obstruction in adults is nasal septum deviation (NSD). The chronic hypoxia caused by this obstruction gradually leads to increased pulmonary vascular resistance, pulmonary hypertension (PHT), and right ventricular (RV) failure. The purpose of this study was to determine changes in RV myocardial functions at the tissue level before, and after surgery in patients with NSD. Subjects and Methods: Fifty-eight patients with symptoms of nasal obstruction and snoring were included in this observational study. Preoperative and postoperative third-month peripheral arterial oxygen saturation (SpO2), and RV systolic and diastolic functions measured by pulmonary artery systolic pressure (PASP), tissue Doppler parameters, and speckle tracking echocardiography (STE) were studied in these patients. Results: We observed a very significant decrease in PASP in the postoperative period (32.54 ± 5.24 mmHg vs. 24.22 ± 4.55 mmHg, p = 0.001). Postoperative SpO2 values, measured at room temperature also increased significantly (93.5 ± 0.82% vs. 95.6 ± 0.79%, p = 0.001). There was a significant improvement after surgery in RV systolic functions, represented by global longitudinal strain (GLS) (21.12 ± 2.07 vs. 22.49 ± 1.89, p = 0.013) and systolic global longitudinal strain rate (GLSRs) (1.30 ± 0.12 vs. 1.38 ± 0.13, p = 0.015). No significant differences in terms of RV diastolic function parameters were detected, including the RV early diastolic global longitudinal strain rate (GLSRe) (1.56 ± 0.21 vs. 1.55 ± 0.26, p = 0.86) and RV late diastolic global longitudinal strain rate (GLSRa) (0.88 ± 0.19; 0.89 ± 0.18, p = 0.76). Conclusion: This study was performed with an advanced technique capable of tissue level examination. The findings demonstrated significant improvement in both chronic hypoxia and RV systolic myocardial functions, measured at the tissue level after nasal surgery.
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Kim KS. In Reference to "Effects of Nasal Septum Deviation and Septoplasty on Cardiac Arrhythmia Risk". Otolaryngol Head Neck Surg 2018; 156:198. [PMID: 28045629 DOI: 10.1177/0194599816671880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Pérez-Riera AR, de Abreu LC, Barbosa-Barros R, Grindler J, Fernandes-Cardoso A, Baranchuk A. P-wave dispersion: an update. Indian Pacing Electrophysiol J 2016; 16:126-133. [PMID: 27924760 PMCID: PMC5197451 DOI: 10.1016/j.ipej.2016.10.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/20/2016] [Indexed: 11/30/2022] Open
Abstract
P-wave dispersion (PWD, Pd or Pdis) is a noninvasive electrocardiographic (ECG) marker for atrial remodeling and predictor for atrial fibrillation (AF). PWD is defined as the difference between the widest and the narrowest P-wave duration recorded from the 12 ECG leads. Increased P-wave duration and PWD reflect prolongation of intraatrial and interatrial conduction time with lack of a well-coordinated conduction system within the atrial muscles, with inhomogeneous, asynchronic, pro-inflammatory and anti-inflammatory effect mediated by interleukin-6 (IL-6) in patients with the CG + GG genotype IL-6 -634C/G polymorphism [1] and discontinuous propagation of sinus impulses mainly between the left and right atria, interstitial/extracellular fibroblast activation and collagen deposition with fibrosis (via TGF-β) in atrial tissue, insufficient blood supply, significant not isotropic myoelectric activity, and thin wall thickness and consequent expansion tendency all well-known electrophysiological characteristics in patients with atrial arrhythmias and especially paroxysmal atrial fibrillation (PAF) [2].
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Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Design of Studies and Scientific Writing Laboratory in the ABC Medicine Faculty, Santo André, São Paulo, Brazil.
| | - Luiz Carlos de Abreu
- Design of Studies and Scientific Writing Laboratory in the ABC Medicine Faculty, Santo André, São Paulo, Brazil; Program in Molecular and Integrative Physiological Sciences (MIPS), Department of Environmental Health, Harvard T.H. Chan School of Public Health, USA
| | - Raimundo Barbosa-Barros
- Coronary Center of the Messejana Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - José Grindler
- Electrocardiology Sector, Central Institute of Clínicas Hospital, Faculty of Medicine, University of São Paulo (HCFMUSP), Brazil
| | - Acácio Fernandes-Cardoso
- Electrocardiology Sector, Central Institute of Clínicas Hospital, Faculty of Medicine, University of São Paulo (HCFMUSP), Brazil
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
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