Repolarization Parameters in Patients with Premature Coronary Artery Disease

Firdevs Ayşenur Ekizler

doi:10.4274/atfm.galenos.2019.63935

Research Article

Prematür Koroner Arter Hastalığında Repolarizasyon Parametreleri

Year 2019, Volume: 72 Issue: 1, 54 - 60, 13.06.2019

Firdevs Ayşenur Ekizler

Abstract

Amaç: Genç bireylerde koroner arter hastalığı nispeten nadir görülür. Literatürde genç yaşta koroner arter hastalığı ile ilgili sınırlı veri mevcuttur. Bu çalışmada yeni tanı almış prematür koroner arter hastalığı olanlarda repolarizasyon parametreleri değerlendirildi.

Gereç ve Yöntem: Çalışmaya toplam 200 hasta [128 erkek, 38,0 (29,3-42,0) yaş] dahil edildi ve bunlardan 100’ü yeni tanı prematür koroner arter hastalığı (yaş ≤45) olan çalışma grubunu oluşturdu. Kalan 100 hasta iyi eşleştirilmiş kontrol grubunu oluşturdu. İki grup arasında DII, V2 ve V6 derivasyonlarında ölçülen, QTc intervali, Tp-e intervali ve Tp-e∕QTc den oluşan repolarizasyon parametreleri karşılaştırıldı.

Bulgular: Median QTc intervali D2 derivasyonunda (430,3 ms ve 405,3 ms, p<0,001),V2 derivasyonunda (433,8 ms ve 404,7 ms, p<0,001) V6 derivasyonunda (430,2 ms ve 401,7 ms, p<0,001); median Tp-e intervali D2 derivasyonunda (80 ms ve 64 ms, p<0,001), V2 derivasyonunda (82 ms ve 74 ms, p<0,001), V6 derivasyonunda (88 ms ve 72 ms, p<0,001); ve median Tp-e/QTc oranı; D2 derivasyonunda (0,188 ve 0,158, p<0,001), V2 derivasyonunda (0,190 ve 0,181, p=0,022) ve V6 derivasyonunda (0,196 ve 0,183, p<0,001) olmak üzere sırasıyla prematür koroner arter hastalığı olanlarda kontrol grubuna göre anlamlı olarak daha yüksek saptandı.

Sonuç: Sonuç olarak, prematür koroner arter hastalığı anormal repolarizasyon dispersiyonu ve dolayısıyla aritmik risk ile ilişkili olabilir.

Keywords

Dispersiyon, Koroner, Prematür, Repolarizasyon

Ethical Statement

Supporting Institution

Project Number

Thanks

References

1. Uhl GS, Farrell PW. Myocardial infarction in young adults: risk factors and natural history. Am Heart J. 1983;105:548-553.
2. Glover MU, Kuber MT, Warren SE, et al. Myocardial infarction before age 36: risk factor and arteriographic analysis. Am J Cardiol. 1982;49:1600-1603.
3. Chouhan L, Hajar HA, Pomposiello JC. Comparison of thrombolytic therapy for acute myocardial infarction in patients aged < 35 and > 55 years. Am J Cardiol. 1993;71:157-159.
4. Egred M, Viswanathan G, Davis GK. Myocardial infarction in young adults. Postgrad Med J. 2005;81:741-745.
5. van Loon JE, de Maat MP, Deckers JW, et al. Prognostic markers in young patients with premature coronary heart disease. Atherosclerosis. 2012;224:213-217.
6. Konishi H, Miyauchi K, Kasai T, et al. Long-term prognosis and clinical characteristics of young adults (</=40 years old) who underwent percutaneous coronary intervention. J Cardiol. 2014;64:171-174.
7. Genest JJ, McNamara JR, Salem DN, et al. Prevalence of risk factors in men with premature coronary artery disease. Am J Cardiol. 1991;67:1185-1189.
8. Christus T, Shukkur AM, Rashdan I, et al. Coronary Artery Disease in Patients Aged 35 or less - A Different Beast? Heart Views. 2011;12:7-11. PubMed PMID: 21731802.
9. Akosah KO, Schaper A, Cogbill C, et al. Preventing myocardial infarction in the young adult in the first place: how do the National Cholesterol Education Panel III guidelines perform? J Am Coll Cardiol. 2003;41:1475- 1479.
10. Doughty M, Mehta R, Bruckman D, et al. Acute myocardial infarction in the young--The University of Michigan experience. Am Heart J. 2002;143:56-62.
11. Morillas P, Bertomeu V, Pabon P, et al. Characteristics and outcome of acute myocardial infarction in young patients. The PRIAMHO II study. Cardiology. 2007;107:217-225.
12. Zimmerman FH, Cameron A, Fisher LD, Myocardial infarction in young adults: angiographic characterization, risk factors and prognosis (Coronary Artery Surgery Study Registry). J Am Coll Cardiol. 1995;26:654-661.
13. Drory Y, Turetz Y, Hiss Y, et al. Sudden unexpected death in persons less than 40 years of age. Am J Cardiol. 1991;68:1388-1392.
14. Arzamendi D, Benito B, Tizon-Marcos H, et al. Increase in sudden death from coronary artery disease in young adults. Am Heart J. 2011;161:574-580.
15. Mirvis DM. Spatial variation of QT intervals in normal persons and patients with acute myocardial infarction. J Am Coll Cardiol. 1985;5:625-631.
16. Antzelevitch C, Shimizu W, Yan GX, et al. The M cell: its contribution to the ECG and to normal and abnormal electrical function of the heart. J Cardiovasc Electrophysiol. 1999;10:1124-1152.
17. Xia Y, Liang Y, Kongstad O, et al. Tpeak-Tend interval as an index of global dispersion of ventricular repolarization: evaluations using monophasic action potential mapping of the epi- and endocardium in swine. J Interv Card Electrophysiol. 2005;14:79-87.
18. Gupta P, Patel C, Patel H, et al. T(p-e)/QT ratio as an index of arrhythmogenesis. J Electrocardiol. 2008;41:567-574.
19. Zhao X, Xie Z, Chu Y, et al. Association between Tp-e/QT ratio and prognosis in patients undergoing primary percutaneous coronary intervention for STsegment elevation myocardial infarction. Clin Cardiol. 2012;35:559-564.
20. Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics--2012 update: a report from the American Heart Association. Circulation. 2012;125:e2-e220. PubMed PMID: 22179539.
21. Chan MY, Woo KS, Wong HB, Chia BL, et al. Antecedent risk factors and their control in young patients with a first myocardial infarction. Singapore Med J. 2006;47:27-30.
22. Chen L, Chester M, Kaski JC. Clinical factors and angiographic features associated with premature coronary artery disease. Chest. 1995;108:364- 369.
23. Klein LW, Agarwal JB, Herlich MB, et al. Prognosis of symptomatic coronary artery disease in young adults aged 40 years or less. Am J Cardiol. 1987;60:1269-1272.
24. Cole JH, Miller JI, 3rd, Sperling LS, et al. Long-term follow-up of coronary artery disease presenting in young adults. J Am Coll Cardiol. 2003;41:521- 528.
25. Goldberg RJ, McCormick D, Gurwitz JH, et al. Age-related trends in shortand long-term survival after acute myocardial infarction: a 20-year population-based perspective (1975-1995). Am J Cardiol. 1998;82:1311- 1317.
26. Holmes DR, Jr., White HD, Pieper KS, et al. Effect of age on outcome with primary angioplasty versus thrombolysis. J Am Coll Cardiol. 1999;33:412- 419.
27. Kors JA, Ritsema van Eck HJ, van Herpen G. The meaning of the Tp-Te interval and its diagnostic value. J Electrocardiol. 2008;41:575-580.
28. Hetland M, Haugaa KH, Sarvari SI, et al. A novel ECG-index for prediction of ventricular arrhythmias in patients after myocardial infarction. Ann Noninvasive Electrocardiol. 2014;19:330-337.
29. Mulay DV, Quadri SM. QT dispersion and early arrhythmic risk in acute myocardial infarction. Indian Heart J. 2004;56:636-641.
30. O’Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of theAmerican College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127:e362-425.
31. Schwartz PJ, Wolf S. QT interval prolongation as predictor of sudden death in patients with myocardial infarction. Circulation. 1978;57:1074-1077.
32. Xianpei W, Sha W, Chuanyu G, et al. Tpeak-Tend dispersion as a predictor for malignant arrhythmia events in patients with vasospastic angina. Int J Cardiol. 2017;249:61-65.
33. Sucu M, Ucaman B, Ozer O, et al. Novel Ventricular Repolarization Indices in Patients with Coronary Slow Flow. J Atr Fibrillation. 2016;9:1446. PubMed PMID: 28496926.
34. Karakaya O, Saglam M, Barutcu I, Kargin R, et al. Effects of isolated coronary artery ectasia on electrocardiographic parameters reflecting ventricular heterogeneity. J Electrocardiol. 2007;40:203-206.
35. Mahmoud K. Effect of isolated coronary artery ectasia on dispersion of P-wave and QT interval. The Egyptian Heart Journal. 2012;64:121-125.
36. Tasolar H, Balli M, Cetin M, et al. Effects of the coronary collateral circulation on the Tp-e interval and Tp-e/QT ratio in patients with stable coronary artery disease. Ann Noninvasive Electrocardiol. 2015;20:53-61.
37. Haarmark C, Hansen PR, Vedel-Larsen E, et al.The prognostic value of the Tpeak-Tend interval in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. J Electrocardiol. 2009;42:555-560.
38. Davies MJ. Pathological view of sudden cardiac death. Br Heart J. 1981;45:88-96. PubMed PMID: 6450599.
39. Acar G, Yorgun H, Inci MF, et al. Evaluation of Tp-e interval and Tp-e/QT ratio in patients with ankylosing spondylitis. Mod Rheumatol. 2013.
40. Mozos I. The link between ventricular repolarization variables and arterial function. J Electrocardiol. 2015;48:145-149.

Repolarization Parameters in Patients with Premature Coronary Artery Disease

Year 2019, Volume: 72 Issue: 1, 54 - 60, 13.06.2019

Firdevs Ayşenur Ekizler

Abstract

Objectives: Coronary artery disease (CAD) in young adults is relatively rare. Few data on CAD in young adults are available in the literature. In the current study, repolarization parameters were evaluated in patients with newly diagnosed premature CAD.

Materials and Methods: A total of 200 patients [128 male, 38.0 (29.3-42.0) years] were included and 100 cases with newly diagnosed premature coronary heart disease (aged ≤45 years) formed the study group. Remaining 100 cases were well-matched controls. Repolarization parameters including QTc interval, Tp-e interval and Tp-e∕QTc in leads DII, V2 and V6 were compared between the two groups.

Results: The median QTc interval (430.3 ms vs 405.3 ms, p<0.001) in lead D2, (433.8 ms vs 404.7 ms, p<0.001) in lead V2 and (430.2 ms vs 401.7 ms, p<0.001) in lead V6; the median Tp-e interval (80 ms vs 64 ms, p<0.001) in lead D2, (82 ms vs 74 ms, p<0.001) in lead V2 and (88 ms vs 72 ms, p<0.001) in lead V6; and the median Tp-e/QTc (0.188 vs 0.158, p<0.001) in lead D2, (0.190 vs 0.181, p=0.022) in lead V2 and (0.196 vs 0.183, p<0.001) in lead V6 were significantly higher in patients with premature CAD compared controls, respectively.

Conclusion: In conclusion, premature coronary heart disease may be related to abnormal dispersion of repolarization and subsequent arrhythmic risk.

Keywords

Coronary, Dispersion, Premature, Repolarization

Ethical Statement

Ethics Committee Approval: This study was submitted to and approved by the Ethics Commission of Turkiye Yuksek Ihtisas Training and Research Hospital (Reference number: E.7415). Informed Consent: This is a retrospective study, so the consent to participate is not applicable. Peer-review: Externally peer-reviewed. Authorship Contributions Concept: F.A.E, S.Ç., B.T.T., Design: F.A.E, S.Ç., H.K., Ö.Ö., F.Ö., S.T., B.T.T, D.A., Data Collection or Processing: A.E., S.Ç., Analysis or Interpretation: A.E., S.Ç., Literature Search: A.E., S.Ç., B.T.T., H.K., Writing: A.E., S.Ç. Conflict of Interest: No conflict of interest was declared by the authors. Financial Disclosure: The authors declared that this study received no financial support.

Supporting Institution

Project Number

Thanks

References

1. Uhl GS, Farrell PW. Myocardial infarction in young adults: risk factors and natural history. Am Heart J. 1983;105:548-553.
2. Glover MU, Kuber MT, Warren SE, et al. Myocardial infarction before age 36: risk factor and arteriographic analysis. Am J Cardiol. 1982;49:1600-1603.
3. Chouhan L, Hajar HA, Pomposiello JC. Comparison of thrombolytic therapy for acute myocardial infarction in patients aged < 35 and > 55 years. Am J Cardiol. 1993;71:157-159.
4. Egred M, Viswanathan G, Davis GK. Myocardial infarction in young adults. Postgrad Med J. 2005;81:741-745.
5. van Loon JE, de Maat MP, Deckers JW, et al. Prognostic markers in young patients with premature coronary heart disease. Atherosclerosis. 2012;224:213-217.
6. Konishi H, Miyauchi K, Kasai T, et al. Long-term prognosis and clinical characteristics of young adults (</=40 years old) who underwent percutaneous coronary intervention. J Cardiol. 2014;64:171-174.
7. Genest JJ, McNamara JR, Salem DN, et al. Prevalence of risk factors in men with premature coronary artery disease. Am J Cardiol. 1991;67:1185-1189.
8. Christus T, Shukkur AM, Rashdan I, et al. Coronary Artery Disease in Patients Aged 35 or less - A Different Beast? Heart Views. 2011;12:7-11. PubMed PMID: 21731802.
9. Akosah KO, Schaper A, Cogbill C, et al. Preventing myocardial infarction in the young adult in the first place: how do the National Cholesterol Education Panel III guidelines perform? J Am Coll Cardiol. 2003;41:1475- 1479.
10. Doughty M, Mehta R, Bruckman D, et al. Acute myocardial infarction in the young--The University of Michigan experience. Am Heart J. 2002;143:56-62.
11. Morillas P, Bertomeu V, Pabon P, et al. Characteristics and outcome of acute myocardial infarction in young patients. The PRIAMHO II study. Cardiology. 2007;107:217-225.
12. Zimmerman FH, Cameron A, Fisher LD, Myocardial infarction in young adults: angiographic characterization, risk factors and prognosis (Coronary Artery Surgery Study Registry). J Am Coll Cardiol. 1995;26:654-661.
13. Drory Y, Turetz Y, Hiss Y, et al. Sudden unexpected death in persons less than 40 years of age. Am J Cardiol. 1991;68:1388-1392.
14. Arzamendi D, Benito B, Tizon-Marcos H, et al. Increase in sudden death from coronary artery disease in young adults. Am Heart J. 2011;161:574-580.
15. Mirvis DM. Spatial variation of QT intervals in normal persons and patients with acute myocardial infarction. J Am Coll Cardiol. 1985;5:625-631.
16. Antzelevitch C, Shimizu W, Yan GX, et al. The M cell: its contribution to the ECG and to normal and abnormal electrical function of the heart. J Cardiovasc Electrophysiol. 1999;10:1124-1152.
17. Xia Y, Liang Y, Kongstad O, et al. Tpeak-Tend interval as an index of global dispersion of ventricular repolarization: evaluations using monophasic action potential mapping of the epi- and endocardium in swine. J Interv Card Electrophysiol. 2005;14:79-87.
18. Gupta P, Patel C, Patel H, et al. T(p-e)/QT ratio as an index of arrhythmogenesis. J Electrocardiol. 2008;41:567-574.
19. Zhao X, Xie Z, Chu Y, et al. Association between Tp-e/QT ratio and prognosis in patients undergoing primary percutaneous coronary intervention for STsegment elevation myocardial infarction. Clin Cardiol. 2012;35:559-564.
20. Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics--2012 update: a report from the American Heart Association. Circulation. 2012;125:e2-e220. PubMed PMID: 22179539.
21. Chan MY, Woo KS, Wong HB, Chia BL, et al. Antecedent risk factors and their control in young patients with a first myocardial infarction. Singapore Med J. 2006;47:27-30.
22. Chen L, Chester M, Kaski JC. Clinical factors and angiographic features associated with premature coronary artery disease. Chest. 1995;108:364- 369.
23. Klein LW, Agarwal JB, Herlich MB, et al. Prognosis of symptomatic coronary artery disease in young adults aged 40 years or less. Am J Cardiol. 1987;60:1269-1272.
24. Cole JH, Miller JI, 3rd, Sperling LS, et al. Long-term follow-up of coronary artery disease presenting in young adults. J Am Coll Cardiol. 2003;41:521- 528.
25. Goldberg RJ, McCormick D, Gurwitz JH, et al. Age-related trends in shortand long-term survival after acute myocardial infarction: a 20-year population-based perspective (1975-1995). Am J Cardiol. 1998;82:1311- 1317.
26. Holmes DR, Jr., White HD, Pieper KS, et al. Effect of age on outcome with primary angioplasty versus thrombolysis. J Am Coll Cardiol. 1999;33:412- 419.
27. Kors JA, Ritsema van Eck HJ, van Herpen G. The meaning of the Tp-Te interval and its diagnostic value. J Electrocardiol. 2008;41:575-580.
28. Hetland M, Haugaa KH, Sarvari SI, et al. A novel ECG-index for prediction of ventricular arrhythmias in patients after myocardial infarction. Ann Noninvasive Electrocardiol. 2014;19:330-337.
29. Mulay DV, Quadri SM. QT dispersion and early arrhythmic risk in acute myocardial infarction. Indian Heart J. 2004;56:636-641.
30. O’Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of theAmerican College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127:e362-425.
31. Schwartz PJ, Wolf S. QT interval prolongation as predictor of sudden death in patients with myocardial infarction. Circulation. 1978;57:1074-1077.
32. Xianpei W, Sha W, Chuanyu G, et al. Tpeak-Tend dispersion as a predictor for malignant arrhythmia events in patients with vasospastic angina. Int J Cardiol. 2017;249:61-65.
33. Sucu M, Ucaman B, Ozer O, et al. Novel Ventricular Repolarization Indices in Patients with Coronary Slow Flow. J Atr Fibrillation. 2016;9:1446. PubMed PMID: 28496926.
34. Karakaya O, Saglam M, Barutcu I, Kargin R, et al. Effects of isolated coronary artery ectasia on electrocardiographic parameters reflecting ventricular heterogeneity. J Electrocardiol. 2007;40:203-206.
35. Mahmoud K. Effect of isolated coronary artery ectasia on dispersion of P-wave and QT interval. The Egyptian Heart Journal. 2012;64:121-125.
36. Tasolar H, Balli M, Cetin M, et al. Effects of the coronary collateral circulation on the Tp-e interval and Tp-e/QT ratio in patients with stable coronary artery disease. Ann Noninvasive Electrocardiol. 2015;20:53-61.
37. Haarmark C, Hansen PR, Vedel-Larsen E, et al.The prognostic value of the Tpeak-Tend interval in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. J Electrocardiol. 2009;42:555-560.
38. Davies MJ. Pathological view of sudden cardiac death. Br Heart J. 1981;45:88-96. PubMed PMID: 6450599.
39. Acar G, Yorgun H, Inci MF, et al. Evaluation of Tp-e interval and Tp-e/QT ratio in patients with ankylosing spondylitis. Mod Rheumatol. 2013.
40. Mozos I. The link between ventricular repolarization variables and arterial function. J Electrocardiol. 2015;48:145-149.

There are 40 citations in total.

Details

Primary Language	English
Subjects	Cardiology
Journal Section	Articles
Authors	Firdevs Ayşenur Ekizler 0000-0002-3988-6828
Project Number	-
Publication Date	June 13, 2019
Published in Issue	Year 2019 Volume: 72 Issue: 1

Cite

APA	Ekizler, F. A. (2019). Repolarization Parameters in Patients with Premature Coronary Artery Disease. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 72(1), 54-60. https://doi.org/10.4274/atfm.galenos.2019.63935
AMA	Ekizler FA. Repolarization Parameters in Patients with Premature Coronary Artery Disease. Ankara Üniversitesi Tıp Fakültesi Mecmuası. June 2019;72(1):54-60. doi:10.4274/atfm.galenos.2019.63935
Chicago	Ekizler, Firdevs Ayşenur. “Repolarization Parameters in Patients With Premature Coronary Artery Disease”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 72, no. 1 (June 2019): 54-60. https://doi.org/10.4274/atfm.galenos.2019.63935.
EndNote	Ekizler FA (June 1, 2019) Repolarization Parameters in Patients with Premature Coronary Artery Disease. Ankara Üniversitesi Tıp Fakültesi Mecmuası 72 1 54–60.
IEEE	F. A. Ekizler, “Repolarization Parameters in Patients with Premature Coronary Artery Disease”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 72, no. 1, pp. 54–60, 2019, doi: 10.4274/atfm.galenos.2019.63935.
ISNAD	Ekizler, Firdevs Ayşenur. “Repolarization Parameters in Patients With Premature Coronary Artery Disease”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 72/1 (June 2019), 54-60. https://doi.org/10.4274/atfm.galenos.2019.63935.
JAMA	Ekizler FA. Repolarization Parameters in Patients with Premature Coronary Artery Disease. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2019;72:54–60.
MLA	Ekizler, Firdevs Ayşenur. “Repolarization Parameters in Patients With Premature Coronary Artery Disease”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 72, no. 1, 2019, pp. 54-60, doi:10.4274/atfm.galenos.2019.63935.
Vancouver	Ekizler FA. Repolarization Parameters in Patients with Premature Coronary Artery Disease. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2019;72(1):54-60.

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