Studies in Medical Sciences
مجله مطالعات علوم پزشکی
Studies in Medical Sciences
Medical Sciences
http://umj.umsu.ac.ir
37
journal37
2717-008X
2717-008X
10.61186/umj
fa
jalali
1394
2
1
gregorian
2015
5
1
26
2
online
1
fulltext
fa
ارتباط شدت آمبولی ریه در سی تی آنژیوگرافی با یافتههای ECG در بیماران مبتلا به آمبولی حاد ریه
THE CORRELATION OF SEVERITY OF PULMONARY EMBOLISM IN CT ANGIOGRAPHY WITH ECG FINDINGS IN PATIENTS WITH ACUTE PULMONARY EMBOLISM
آناتومی
آناتومی
پژوهشي(توصیفی- تحلیلی)
Research
<p class="Chekide" style="TEXT-JUSTIFY: kashida TEXT-ALIGN: justify TEXT-KASHIDA: 0% MARGIN: 0in 0in 0pt unicode-bidi: embed DIRECTION: rtl" dir="rtl"><b><span lang="AR-SA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt">پیشزمینه و هدف:</span></b><span lang="AR-SA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt"> </span><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA">شایعترین مودالیته تشخیصی آمبولی ریه، </span><font size="2"><font face="Times New Roman"><span dir="ltr">CT</span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> آنژیوگرافی </span><span dir="ltr"></span><span dir="ltr"><span dir="ltr"></span><font face="Times New Roman" size="2">(CTA)</font></span><span dir="rtl"></span><span style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> <span lang="FA"><font face="Nazanin" size="2">هست. به علت ارزان بودن و در دسترس بودن، ارزیابی الکتروکاردیوگرام </font></span></span><span dir="ltr"></span><span dir="ltr"><span dir="ltr"></span><font face="Times New Roman" size="2">(ECG)</font></span><span dir="rtl"></span><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> اولین اقدام در بیماران مشکوک به آمبولی ریه هست. بااینحال، </span><font size="2"><font face="Times New Roman"><span dir="ltr">ECG</span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> هیچ معیار یا تظاهرات حساس یا اختصاصی را برای شناسایی آمبولی ریه ارائه نمیدهد. لذا بر آن شدیم تا ارتباط شدت آمبولی ریه در </span><font size="2"><font face="Times New Roman"><span dir="ltr">CTA</span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> را با تغییرات </span><font size="2"><font face="Times New Roman"><span dir="ltr">ECG</span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> ارزیابی نماییم.<p></p></span></p><p class="Chekide" style="TEXT-JUSTIFY: kashida TEXT-ALIGN: justify TEXT-KASHIDA: 0% MARGIN: 0in 0in 0pt unicode-bidi: embed DIRECTION: rtl" dir="rtl"><b><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA">روش کار:</span></b><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"> </span><span lang="AR-SA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt">در این مطالعه، تعداد 102 بیمار که در مطالعات </span><font size="2"><font face="Times New Roman"><span dir="ltr">CTA</span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> برای آنها تشخیص </span><span lang="AR-SA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt">آمبولی </span><font size="2"><font face="Times New Roman"><span dir="ltr">Massive</span><span dir="rtl"></span></font></font><span style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> <span lang="FA"><font face="Nazanin" size="2">یا </font></span></span><font size="2"><font face="Times New Roman"><span dir="ltr">Submassive</span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> بر اساس </span><font size="2"><font face="Times New Roman"><span dir="ltr">Qanadli index</span><span dir="rtl"></span></font></font><span style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> <span lang="FA"><font face="Nazanin" size="2">دادهشده بود، ارزیابی شدند. از تمامی بیماران </font></span></span><font size="2"><font face="Times New Roman"><span dir="ltr">ECG</span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> به عمل آمد. 35 یافته پاتولوژیک در </span><font size="2"><font face="Times New Roman"><span dir="ltr">ECG</span><span dir="rtl"></span></font></font><span style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> <span lang="FA"><font face="Nazanin" size="2">قبلاً گزارش شدهاند که همگی در این بیماران ارزیابی شدند. ارتباط بین یافتههای </font></span></span><font size="2"><font face="Times New Roman"><span dir="ltr">ECG</span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> و شدت آمبولی در </span><font size="2"><font face="Times New Roman"><span dir="ltr">CTA</span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> ارزیابی شد.<p></p></span></p><p class="Chekide" style="TEXT-JUSTIFY: kashida TEXT-ALIGN: justify TEXT-KASHIDA: 0% MARGIN: 0in 0in 0pt unicode-bidi: embed DIRECTION: rtl" dir="rtl"><b><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA">نتایج</span></b><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA">: آمبولی </span><font size="2"><font face="Times New Roman"><span dir="ltr">massive</span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> در 9/56 درصد و آمبولی </span><font size="2"><font face="Times New Roman"><span dir="ltr">submassive</span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> در 1/43 درصد موارد وجود داشت. در 5/76 درصد تغییرات </span><font size="2"><font face="Times New Roman"><span dir="ltr">ECG</span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> به نفع آمبولی وجود داشت. در موارد امبولی </span><font size="2"><font face="Times New Roman"><span dir="ltr">Massive</span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> نسبت به آمبولی </span><font size="2"><font face="Times New Roman"><span dir="ltr">submassive</span><span dir="rtl"></span></font></font><span style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> <span lang="FA"><font face="Nazanin" size="2">بهطور بارزی تغییرات </font></span></span><font size="2"><font face="Times New Roman"><span dir="ltr">ECG</span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> بیشتر (2/86 درصد در برابر 6/63 درصد) و میانگین تعداد یافتههای </span><font size="2"><font face="Times New Roman"><span dir="ltr">ECG</span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> بیشتری وجود داشت (95/2±82/5 در برابر 84/2±25/4). فراوانی </span><font size="2"><font face="Times New Roman"><span dir="ltr">S1Q3T3 pattern</span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span>، </span><font size="2"><font face="Times New Roman"><span dir="ltr">S1&SaVL>1.5 mm</span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span>، </span><font size="2"><font face="Times New Roman"><span dir="ltr">ST depression in V<sub>1</sub>-V<sub>3</sub></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span>، </span><font size="2"><font face="Times New Roman"><span dir="ltr">ST elevation in V1-V3</span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span>، </span><font size="2"><font face="Times New Roman"><span dir="ltr">Negative T wave in V<sub>1</sub>-V<sub>3</sub></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span>، </span><font size="2"><font face="Times New Roman"><span dir="ltr">Right axis deviation</span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span>، </span><font size="2"><font face="Times New Roman"><span dir="ltr">RVH criteria</span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span>، </span><font size="2"><font face="Times New Roman"><span dir="ltr">P-pulmonale</span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span>، </span><font size="2"><font face="Times New Roman"><span dir="ltr">QR pattern in V1</span><span dir="rtl"></span></font></font><span style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> <span lang="FA"><font face="Nazanin" size="2">بهطور بارزی در گروه </font></span></span><font size="2"><font face="Times New Roman"><span dir="ltr">Massive</span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> آمبولی بیشتر بود.<p></p></span></p><p class="Chekide" style="TEXT-JUSTIFY: kashida TEXT-ALIGN: justify TEXT-KASHIDA: 0% MARGIN: 0in 0in 0pt unicode-bidi: embed DIRECTION: rtl" dir="rtl"><b><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA">نتیجهگیری:</span></b><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"> وجود تغییرات </span><font size="2"><font face="Times New Roman"><span dir="ltr">ECG</span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> و نیز تعداد تغییرات </span><font size="2"><font face="Times New Roman"><span dir="ltr">ECG</span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> در گروه آمبولی </span><font size="2"><font face="Times New Roman"><span dir="ltr">Massive</span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> بالاتر میباشند. عمده تغییرات معنیدار در مورد </span><font size="2"><font face="Times New Roman"><span dir="ltr">ST depression</span><span dir="rtl"></span></font></font><span style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> <span lang="FA"><font face="Nazanin" size="2">یا </font></span></span><font size="2"><font face="Times New Roman"><span dir="ltr">elevation</span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> و </span><font size="2"><font face="Times New Roman"><span dir="ltr">Negative T</span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> در لیدهای </span><font size="2"><font face="Times New Roman"><span dir="ltr">V1-V3</span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><span dir="rtl"></span> و یافتههای مرتبط با درگیری سمت راست قلب بودند و میتوانند برای پیشبینی شدت آمبولی ریه استفاده شوند.<p></p></span></p><p class="Chekide" style="TEXT-JUSTIFY: kashida TEXT-ALIGN: justify TEXT-KASHIDA: 0% MARGIN: 0in 0in 0pt unicode-bidi: embed DIRECTION: rtl" dir="rtl"><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"></span></p><p class="Chekide" style="TEXT-JUSTIFY: kashida TEXT-ALIGN: justify TEXT-KASHIDA: 0% MARGIN: 0in 0in 0pt unicode-bidi: embed DIRECTION: rtl" dir="rtl"><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt mso-bidi-language: FA"><p> </p></span></p>
<p> <strong> </strong></p><p> <strong><i>Background & Aims</i>:</strong> The most common diagnostic modality for pulmonary emboli is CT angiography (CTA). Because of the availability and inexpensiveness, taking an electrocardiogram (ECG) is the first step in patients suspicious to pulmonary emboli. However, ECG does not provide any sensitive or specific manifestations for diagnosis of pulmonary emboli. We aim to evaluate the correlation between severity of pulmonary emboli in CTA and ECG changes. </p><p> <strong><i>Materials & Methods</i>:</strong> In this study, 102 patients diagnosed with massive or submassive pulmonary emboli due to Qanadli index in CTA studies were evaluated. ECG was taking in all patients. There are 35 previously reported pathologic changes in ECG which were all evaluated in these patients. The correlation between ECG findings and pulmonary emboli severity in CTA was evaluated.</p><p> <strong><i>Results</i>:</strong> Massive emboli were present in 56.9% and submassive emboli in 43.1% of cases. In 76.5% of cases, pathologic changes in ECG considering emboli were present. In cases with massive emboli compared to submassive emboli, ECG changes (86.2% vs. 63.6%) and mean pathologic findings in ECG (5.82±2.95 vs. 4.25±2.84) were significantly higher. Prevalence of S1O3T3, S1&SaVL>1.5 mm, ST depression in V<sub>1</sub>-V<sub>3</sub>, ST elevation in V1-V3, Negative T wave in V<sub>1</sub>-V<sub>3</sub>, Right axis deviation, RVH criteria, P-pulmonale, QR pattern in V1 were significantly higher in massive emboli group. </p><p> <strong><i>Conclusion</i>:</strong> ECG changes and number of pathologic findings were higher in massive emboli group. Most significant changes were negative T and ST depression or elevation in V1-V3 and right heart involvement findings and could predict severity of pulmonary emboli. </p><p> </p><p> SOURCE: URMIA MED J 2015: 26(2): 165 ISSN: 1027-3727 </p>
آمبولی ریه, الکتروکاردیوگرام, سی تی آنژیوگرافی
Pulmonary emboli, Electrocardiogram, CT angiography
166
175
http://umj.umsu.ac.ir/browse.php?a_code=A-10-582-583&slc_lang=fa&sid=1
Mohammad Kazem
Tarzamni
محمدکاظم
طرزمنی
3700319475328460011724
3700319475328460011724
No
Radiology Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
دپارتمان رادیولوژی، دانشکده پزشکی، دانشگاه علوم پزشکی تبریز، تبریز، ایران
Babak
Kazemi
بابک
کاظمی
3700319475328460011725
3700319475328460011725
No
Radiology Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
دپارتمان رادیولوژی، دانشکده پزشکی، دانشگاه علوم پزشکی تبریز، تبریز، ایران
Reza
Javadrashid
رضا
جواد رشید
3700319475328460011726
3700319475328460011726
No
Radiology Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
دپارتمان رادیولوژی، دانشکده پزشکی، دانشگاه علوم پزشکی تبریز، تبریز، ایران
Shirin
Jahed Khangah
شیرین
جاهد خانقاه
mashrabi1383@yahoo.com
3700319475328460011727
3700319475328460011727
Yes
Radiology Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
دپارتمان رادیولوژی، دانشکده پزشکی، دانشگاه علوم پزشکی تبریز، تبریز، ایران (