Akut serebrovasküler olaylarda malign ventriküler aritminin risk göstergeleri olarak Tpe, Tpe dispersiyon ve Tpe/QT oran,
As the risk indicators of malign ventricular arhytmia, the Tpe, Tpe dispersion and rate of Tpe/QT in acute cerebrovascular events
Yazar: NİHAL TEKİNALP
Danışman: DOÇ. DR. FİGEN GÜNEY
Necmettin Erbakan Üniversitesi / Meram Tıp Fakültesi / Nöroloji Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2013
Konu: Nöroloji = Neurology
Dizin: Aritmi-kardiyak = Arrhythmia-cardiac ; Elektrokardiyografi = Electrocardiography ; Hemorajiler = Hemorrhage ; Serebrovasküler bozukluklar = Cerebrovascular disorders ; Serebrovasküler dolaşım = Cerebrovascular circulation ; Ventriküler fonksiyon = Ventricular function ; İskemi = Ischemia

Özet:
Amaç: Bu çalÕúmada amacÕPÕz, iskemik inme, hemorajik inme ve geçici iskemik atak
hastalarÕnda ventriküler aritmilerin yeni göstergeleri olan Tpe, Tpe-d ve Tpe/QT oranÕQÕn
nasÕl etkilendi÷ini incelemektir.
Materyal ve Metod: Necmettin Erbakan Üniversitesi Meram TÕp Fakültesi Nöroloji ve Acil
Servisine baúvuran akut serebrovasküler olay geçiren hastalar alÕndÕ. Hastalar 30 akut iskemik
inme, 20 akut hemorajik inme ve 30 geçici iskemik atak olmak üzere üç gruba ayrÕldÕ. Kontrol
grubu olarak yaú ve cinsiyet uyumlu, herhangi bir nedenle EKG çekilmiú 30 sa÷OÕklÕ birey
alÕndÕ. Tüm katÕOÕmcÕlarÕn baúvuruda rutin olarak çekilen EKG'leri manuel olarak incelendi.
QT, QTc ve QTc dispersiyonu (QTcd) tüm leadlerde incelenirken, Tpeak-Tend (Tpe), Tpe
dispersiyonu (Tpe-d) ve Tpe/QT oranÕ sadece prekordial leadlerde incelendi.
Bulgular: øskemik inme (ort. yaú 61.17 ± 14.14 yÕl; 15 kadÕn/15 erkek) ve hemorajik inme
(ort. yaú 65.05 ± 9.50 yÕl; 10 kadÕn/10 erkek) grubunda hem eski (QT, QTc, QTcd) hem de
yeni (Tpe, Tpe-d, Tpe/QT oranÕ) aritmi parametreleri kontrol (ort. yaú 58.27 ± 10.45 yÕl; 15
kadÕn/15 erkek) ve geçici iskemik atak (ort. yaú 58.10 ± 13.32 yÕl; 15 kadÕn/15 erkek)
hastalarÕna kÕyasla anlamlÕúekilde uzamÕúWÕ. Bu uzama V5 ve V6. derivasyona özgüydü. Eski
parametreler, ek olarak DII leadinde de uzamÕúWÕ. Yaú ile Tpe, QTcmax ve QTd arasÕnda
pozitif korelasyon vardÕ (sÕrasÕyla r= 0.21, p= 0.028; r= 0.19, p= 0.032 ve r= 0.22, p= 0.013).
Sonuç: Hem iskemik inme, hem de hemorajik inme hastalarÕnda ventrikülün global
repolarizasyonuna ek olarak transmural repolarizasyonu da artmÕúWÕr. EKG üzerinde V5 ve V6
leadleri aritmilerin tespitinde akut inme hastalarÕ için oldukça önemlidir. Bu konuda ileri
çalÕúmalara ihtiyaç vardÕr.
Anahtar Kelimeler: ønme, Elektrokardiyografi, Aritmi

Abstract:
As The Risk Indicators of Malign Ventricular Arhytmia, The Tpe, Tpe Dispersion and
Rate of Tpe/QT in Acute Cerebrovascular Events, Nihal Tekinalp, Expertise Thesis,
Konya, 2013
Objective: To investigate how Tpe, Tpe-d and Tpe/QT rate, the novel indicators of
ventricular arhytmias, are affected in patients with ischemic stroke, hemorrhagic stroke and
transient ischemic attacks.
Materials and Methods: Experiencing acute cerebrovascular events, the patients that were
admitted to Departments of Neurology and Emergency of Meram Medical School, Necmettin
Erbakan University were included. Patients were put into three groups as 30 with acute
ischemic stroke, 20 with acute hemorrhagic stroke and 30 with transient ischemic attack.
Thirty healthy individuals matched as age and sex, and undergoing ECG due to any reason
constituted controls. All ECG results taken routinely on admission were manually assessed.
While QT, QTc and QTc dispersion (QTcd) were investigated in all leads, Tpeak-tend (Tpe),
Tpe dispersion (Tpe-d) and Tpe/QT rate were investigated only in precordial leads.
Results: In ischemic stroke group (mean age rate, 61.17±14.14 years; 15 women/15 men) and
hemoorrhagic stroke group (mean age rate, 65.05±9.50 years; 10 women/10 men), both
previous (QT, QTc and QTcd) and new (Tpe, Tpe-d and Tpe/QT rate) arhytmic parameters
were significantly more prolonged, compared to controls (mean age rate, 58.27±10.45 years;
15 women/15 men) and patients with transient ischemic attack (mean age rate 58.10±13.32
years; 15 women/15 men). The prolonged parameter was specific to the derivations of V5 and
V6. Previous parameters were also prolonged to the lead of DII. A positive correlation was
present between the age, and Tpe, QTcmax and QTd (r= 0.21, p= 0.028; r= 0.19, p= 0.032;
and, r= 0.22, p= 0.013, respectively).
Conclusion: As well as global repolarization of ventricle both in patients with ischemic
stroke and in those with hemorrhagic stroke, transmural repolarization was also increased. V5
and V6 leads on ECG are quite significant in the determination of arhytmias for patients with
acute stroke, and further studies concerning the condition are needed.