Thesis
Correlation between P Wave Dispersion, QRS Duration & QT Dispersion in Hospital Events in Cases of Acute Coronary Syndrome
Mahmoud Fekry Hassan Hassebo, M.B. B.Ch
Visiting Resident, Faculty of Medicine, Department of Critical Care Medicine, Alexandria University
Corresponding author
Mahmoud Fekry Hassan Hassebo, M.B. B.Ch, Visiting Resident, Faculty of Medicine, Department of Critical Care Medicine, Alexandria University, Hospitals University of Alexandria, Egypt, E-mail: mahmoudhassebo@yahoo.com
Received Date: 29th October 2015
Accepted Date: 11th February 2016
Published Date: 15th February 2016
Citation
Hassebo MFH (2016) Correlation between P Wave Dispersion, QRS Duration & QT Dispersion in Hospital Events in Cases of Acute Coronary Syndrome. Enliven: Clin Cardiol Res 3(S1): 001.
Copyright
@ 2016 Dr. Mahmoud Fekry Hassan Hassebo. This is an Open Access article published and distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Results
|
Unstable Angina |
Successful Thrombolysis |
Failed Thrombolysis |
p |
|||
|
No |
% |
No |
% |
No |
% |
|
Sex |
|
||||||
Male |
14 |
70.0 |
19 |
95.0 |
15 |
75.0 |
MCP = 0.124 |
Female |
6 |
30.0 |
1 |
5.0 |
5 |
25.0 |
|
Age (years) |
|
||||||
Min. – Max. |
39.0 – 75.0 |
30.0 – 73.0 |
47.0 – 70.0 |
Fp= 0.937 |
|||
Mean ± SD |
57.35 ± 9.87 |
57.20 ± 11.37 |
56.30 ± 8.24 |
||||
Median |
56.50 |
60.0 |
52.0 |
Table 1: Comparison between the Different Studied Groups According to Demographic Data
p: p value for comparing between the studied group
MC: Monte Carlo test
F: F test (ANOVA)
*: Statistically significant at p ≤ 0.05
There was no significant difference between the gender of patients in the three groups of patients (p >0.05), total number of males was 48, however in females was 12.
There was also no significant difference between the three age groups of patients (p >0.05), mean of age was similar (57.3, 57.2 and 56.3 years) respectively.
|
Unstable |
Successful Thrombolysis |
Failed Thrombolysis |
p |
|||
|
No |
% |
No |
% |
No |
% |
|
DM |
|
|
|
|
|
|
|
+ve |
11 |
55.0 |
4 |
20.0 |
7 |
35.0 |
x2p = 0.070 |
-ve |
9 |
45.0 |
16 |
80.0 |
13 |
65.0 |
|
x2p1 |
|
0.022* |
0.204 |
|
|||
FEp2 |
|
0.015* |
|
||||
Hypertension |
|
|
|
|
|
|
|
+ve |
11 |
55.0 |
7 |
35.0 |
5 |
25.0 |
x2p = 0.139 |
-ve |
9 |
45.0 |
13 |
65.0 |
15 |
75.0 |
|
Heart disease |
|
|
|
|
|
|
|
+ve |
15 |
75.0 |
18 |
90.0 |
13 |
65.0 |
MCp = 0.201 |
-ve |
5 |
25.0 |
2 |
10.0 |
7 |
35.0 |
|
Smoking |
|
|
|
|
|
|
|
+ve |
4 |
20.0 |
15 |
75.0 |
9 |
45.0 |
x2p = 0.002* |
-ve |
16 |
80.0 |
5 |
25.0 |
11 |
55.0 |
|
x2p1 |
|
<0.001* |
0.091 |
|
|||
x2p2 |
|
0.053 |
|
||||
Cardiac enzymes |
|
|
|
|
|
|
|
+ve |
0 |
0.0 |
20 |
100.0 |
20 |
100.0 |
x2p <0.001* |
-ve |
20 |
100.0 |
0 |
0.0 |
0 |
0.0 |
|
x2p1 |
|
<0.001* |
<0.001* |
|
|||
p2 |
|
- |
|
||||
ECG changes |
|
|
|
|
|
|
|
Non significant change |
8 |
40.0 |
0 |
0.0 |
0 |
0.0 |
MCp <0.001* |
Positive change |
12 |
60.0 |
20 |
100.0 |
20 |
100.0 |
|
FEp1 |
|
0.003* |
0.003* |
|
|||
p2 |
|
- |
|
Table 2: Comparison between the Different Studied Groups According to Medical History
P: p value for comparing between the studied group
p1: p value for comparing between unstable angina with each other groups
p2: p value for comparing between successful thrombolysis and failed thrombolysis
MC: Monte Carlo test
FE: Fisher Exact test
x2: Chi square test
*: Statistically significant at p ≤ 0.05
This table shows that there was significant difference in risk factors between the studied groups as following: smoking is higher in the groups (Successful thrombolysis and failed thrombolysis) than the unstable angina group.
There was also significant ECG changes and Cardiac enzymes were elevated in the (Successful thrombolysis and failed thrombolysis) than the unstable angina group.
|
Unstable Angina |
Successful Thrombolysis |
Failed Thrombolysis |
p |
PWD |
(n = 20) |
(n = 20) |
(n = 18) |
|
Min. – Max. |
20.0 – 60.0 |
20.0 – 60.0 |
20.0 – 60.0 |
KWp = 0.624 |
Mean ± SD |
48.0 ± 13.61 |
47.0 ± 13.42 |
43.33 ± 15.72 |
|
Median |
50.0 |
40.0 |
40.0 |
|
MWp1 |
|
0.787 |
0.357 |
|
MWp2 |
|
0.485 |
|
Table 3: Comparison between the Different Studied Groups according to P Wave Dispersion (PWD)
p: p value for Kruskal Wallis test for comparing between the studied group
p1 : p value for Mann Whitney test for comparing between unstable angina with each other groups
p2 : p value for Mann Whitney test for comparing between successful thrombolysis and failed thrombolysis
*: Statistically significant at p ≤ 0.05
This table shows that no difference in PWD between the three groups.
|
Unstable Angina |
Successful Thrombolysis |
Failed Thrombolysis |
p |
QRS |
|
|
|
|
Min. – Max. |
50.0 – 100.0 |
40.0 – 120.0 |
50.0 – 90.0 |
Fp = 0.681 |
Mean ± SD |
73.50 ± 14.24 |
72.0 ± 17.95 |
76.0 ± 10.46 |
|
Median |
80.0 |
70.0 |
80.0 |
|
Schp1 |
|
0.948 |
0.863 |
|
Schp2 |
|
0.687 |
|
Table 4: Comparison between the Different Studied Groups according to QRS Duration
P: p value for F test (ANOVA) for comparing between the studied group
p1: p value for Post Hoc Test (Scheffe) for comparing between unstable angina with each other groups
p2: p value for Post Hoc Test (Scheffe) for comparing between successful thrombolysis and failed thrombolysis
*: Statistically significant at p ≤ 0.05
This table shows that there was no difference in duration of QRS between the three groups (P >0.05), QRS mean was ranged from 73.5 MS in patients with unstable angina, and 76 MS in patients with failed thrombolysis.
|
Unstable Angina |
Successful Thrombolysis |
Failed Thrombolysis |
p |
QTD |
|
|
|
|
Min. – Max. |
39.0 – 129.0 |
9.0 – 125.0 |
28.0 – 187.0 |
Fp = 0.025 |
Mean ± SD |
83.50 ± 31.11 |
72.30 ± 31.47 |
101.0 ± 36.35 |
|
Schp1 |
|
0.566 |
0.239 |
|
Schp2 |
|
0.025 |
|
Table 5: Comparison between the Different Studied Groups according to QT Dispersion (QTD)
P: p value for F test (ANOVA) for comparing between the studied group
p1: p value for Post Hoc Test (Scheffe) for comparing between unstable angina with each other groups
p2: p value for Post Hoc Test (Scheffe) for comparing between successful thrombolysis and failed thrombolysis
*: Statistically significant at p ≤ 0.05
This table shows that there is significant difference in QTD between the three groups, it was longer in patients with failed thrombolysis therapy (101 m sec), than in other groups of patients, (72.3 msec) in patients with successful thrombolytic therapy, ( 83.5 m sec) in patients with unstable angina.
|
Unstable Angina |
Successful Thrombolysis |
Failed Thrombolysis |
p |
|||
|
No |
% |
No |
% |
No |
% |
|
ICU length |
|
|
|
|
|
|
|
<3 days |
19 |
95.0 |
9 |
45.0 |
7 |
35.0 |
X2p <0.001* |
>3 days |
1 |
5.0 |
11 |
55.0 |
13 |
65.0 |
|
X2p1 |
|
0.001* |
<0.001* |
|
|||
X2p2 |
|
0.519 |
|
||||
Min. – Max. |
1.0 – 4.0 |
2.0 – 4.0 |
2.0 – 5.0 |
Fp <0.001* |
|||
Mean ± SD |
2.45 ± 0.76 |
3.50 ± 0.61 |
3.60 ± 0.88 |
||||
Median |
2.50 |
4.0 |
4.0 |
||||
Schp1 |
|
<0.001* |
<0.001* |
|
|||
Schp2 |
|
0.917 |
|
Table 6: Comparison between the Different Studied Groups according to ICU Length P: p value for comparing between the studied groups
p1: p value for comparing between unstable angina with each other groups
p2: p value for comparing between successful thrombolysis and failed thrombolysis
F: F test (ANOVA)
Sch: Post Hoc Test (Scheffe)
x2: Chi square test
*: Statistically significant at p ≤ 0.05
This table shows that there is a significant difference between the three groups ICU length of stay , patients with failed thrombolysis stayed more than 3 days in ICU, in comparison to the other groups.
|
Unstable Angina |
Successful Thrombolysis |
Failed Thrombolysis |
MCp |
|||
|
No |
% |
No |
% |
No |
% |
|
Complications |
|
|
|
|
|
|
|
Absent |
20 |
100.0 |
20 |
100.0 |
13 |
65.0 |
0.001* |
Present |
0 |
0.0 |
0 |
0.0 |
7 |
35.0 |
|
FEp1 |
|
- |
0.008* |
|
|||
FEp2 |
|
0.008* |
|
||||
Heart failure |
0 |
0.0 |
0 |
0.0 |
2 |
10.0 |
- |
Cardiogenc Shock |
0 |
0.0 |
0 |
0.0 |
2 |
10.0 |
|
Accelerated junctiontial rythm |
0 |
0.0 |
0 |
0.0 |
1 |
5.0 |
|
AF |
0 |
0.0 |
0 |
0.0 |
1 |
5.0 |
|
Pulsless VT |
0 |
0.0 |
0 |
0.0 |
1 |
5.0 |
Table 7: Comparison between the Different Studied Groups according to Complications
P: p value for Monte Carlo test for comparing between the studied groups
p1: p value for Fisher Exact test for comparing between unstable angina with each other groups
p2: p value for Fisher Exact test for comparing between successful thrombolysis and failed thrombolysis
*: Statistically significant at p ≤ 0.05
This table shows that the presence of listed complications was only in the failed thrombolysis group in comparison to the other two groups.
|
Unstable Angina |
Successful Thrombolysis |
Failed Thrombolysis |
MCp |
|||
|
No |
% |
No |
% |
No |
% |
|
Survival |
|
|
|
|
|
|
|
Survived |
20 |
100.0 |
20 |
100.0 |
16 |
80.0 |
0.029* |
Non survived |
0 |
0.0 |
0 |
0.0 |
4 |
20.0 |
|
FEp1 |
|
- |
0.106 |
|
|||
FEp2 |
|
0.106 |
|
Table 8: Comparison between the Different Studied Groups according to Survival
P: p value for Monte Carlo test for comparing between the studied groups
p1: p value for Fisher Exact test for comparing between unstable angina with each other groups
p2: p value for Fisher Exact test for comparing between successful thrombolysis and failed thrombolysis
*: Statistically significant at p ≤ 0.05
It was found that percent of survivors in unstable angina and patients with successful thrombolysis was 100% in comparison with 80% of failed thrmobolysis group, that was highly significant (p < 0.001*).
|
Complications |
p |
|
|
Absent |
Present |
|
PWD |
(n = 13) |
(n = 7) |
MWp = 0.208 |
Min. – Max. |
20.0 – 60.0 |
20.0 – 40.0 |
|
Mean ± SD |
46.15 ± 17.10 |
36.0 ± 8.94 |
|
Median |
60.0 |
40.0 |
|
QRS |
(n = 13) |
(n = 7) |
tp = 0.104 |
Min. – Max. |
50.0 – 90.0 |
80.0 – 80.0 |
|
Mean ± SD |
73.85 ± 12.61 |
80.0 ± 0.0 |
|
Median |
80.0 |
80.0 |
|
QTD |
(n = 13) |
(n = 7) |
tp = 0.022* |
Min. – Max. |
36.0 – 102.0 |
28.0 – 187.0 |
|
Mean ± SD |
83.15 ± 17.47 |
121.86 ± 51.68 |
|
Median |
82.0 |
119.0 |
Table 9: Relation between P Wave Dispersion (PWD), QRS Duration, QT Dispersion (QTD) and Complications in failed thrombolysis group
P: p value for comparing between the studied groups
t: Student t-test
MW: Mann Whitney test
*: Statistically significant at p ≤ 0.05
This table shows that there is no significant difference between the PWD, QRS duration and the presence of complications in failed thrombolysis group, however there is a significant difference between the QTD and the complications in the same group.
Complications |
QTD |
Anova |
P value |
|
79.9 ± 28.39 |
6.95 |
<0.001* |
Table 10: Relation between QTD and Complications
*Highly significant= p < 0.001*
There was a highly significant difference between QTD in relation to occurrence of each complications, the largest one was in heart failure (190 msec) and the smallest one was (28 msec) in Junctional arrhythmia.
|
Complications |
p |
|||
Absent |
Present |
||||
No |
% |
No |
% |
||
Survival |
|
|
|
|
|
Survived |
13 |
100.0 |
3 |
42.9 |
0.007* |
Non survived |
0 |
0.0 |
4 |
57.1 |
Table 11: Relation between Survival and Complications in Failed Thrombolysis Group
P: p value for Fisher Exact test for comparing between the two studied groups
*: Statistically significant at p ≤ 0.05
This table shows that non survived patients were 4 from 7 complicated patients (57.1%), their causes of death were (heart failure, cardiogenic shock, AF and pulseless VT), in comparison to the survived patients 3 from 7 complicated patients (42.9%), with a statistical difference <0.05.
|
Complications |
p |
|||
Absent |
Present |
||||
No |
% |
No |
% |
||
ICU length |
|
|
|
|
|
<3 days |
7 |
53.8 |
0 |
0.0 |
FEp = 0.044* |
>3 days |
6 |
46.2 |
7 |
100.0 |
|
Min. – Max. |
2.0 – 4.0 |
4.0 – 5.0 |
tp = 0.007* |
||
Mean ± SD |
3.23 ± 0.83 |
4.29 ± 0.49 |
|||
Median |
3.0 |
4.0 |
Table 12: Relation between ICU Length and Complications in Failed Thrombolysis Group
p: p value for comparing between the studied group
t: Student t-test
FE: Fisher Exact test
*: Statistically significant at p ≤ 0.05
This table shows significant difference between complicated & non complicated patients regarding ICU stay, all complicated patients (100%) stayed more than 3 days in ICU while only 6 from 13 patients (46%) from complicated patients stayed more than 3 days.