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The Evaluation of Lesion Localization and Ischemic Myocardial Mass Via Arrhythmia Parameters in Stable Coronary Artery Patients with Myocardial Ischemia

Year 2025, Volume: 12 Issue: 2, 105 - 112, 28.08.2025
https://doi.org/10.47572/muskutd.1610666

Abstract

The aim of this study was to evaluate which critical coronary artery stenosis is more arrhythmogenic in stable coronary artery disease and whether the involved stenotic artery or the size of the myocardial tissue under ischemia due to stenosis is more important in terms of malignant ventricular arrhythmias by using arrhythmia predictors calculated on electrocardiography. This was a retrospective observational study. We scanned patients who underwent percutaneous coronary intervention for single vessel stable coronary artery disease between January 2013 and 2016. Assigned indicators of increased arrhythmogenic risk as TpTe interval, QTc interval and TpTe/QT ratio were calculated on electrocardiography before and after the percutaneous coronary intervention. We also calculated the anatomical myocardial area at risk of ischemia as a percentage of the left ventricular myocardium volume for a given site of lesion with APPROACH score by assessing coronary angiography images. The percentage of left ventricular jeopardized myocardium in left anterior descending artery lesions (34±10) was significantly higher than those in circumflex artery (17±11) and right coronary artery (21±5) lesions (p<0.001). Furthermore, the differences between TpTe intervals and TpTe/QT ratios measured before and after the percutaneous coronary intervention were significantly higher in patients with left anterior descending artery lesions than patients with circumflex artery and right coronary artery lesions (p<0.001). In patients with stable coronary artery disease, the size of the ischemic myocardium was associated with increased arrhythmogenesis. Patients with left anterior descending artery lesions may get the greatest benefit from revascularization in terms of arrhythmia predictors calculated on electrocardiography.

Ethical Statement

The study was approved by the Ethics Committee of Istanbul Medipol University Faculty of Medicine on 10/08/2016 with number E.13015. The study was conducted in accordance with the principles of the Declaration of Helsinki and written consent was obtained from all patients. Artificial intelligence technology was not used in our study

Supporting Institution

The authors have received no financial support for researching, writing and/or publishing this article.

Thanks

All researchers who contributed to the study are listed among the authors.

References

  • Vrints C, Andreotti F, Koskinas KC et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024;45(36):3415-537.
  • Chockalignam A, Balaguer-Vintro, Achutti A, et al. Impending global pandemic of cardiovascular diseases; challenges and opportunities for the prevention and control of cardiovascular diseases in developing countries and economies in transition. Can J Cardiol. 2000;16(2):231-5.
  • Gach O, Davin L, Lempereur M, et al. Diagnostic coronarography. Rev Med Liege. 2019;74(1):17-21.
  • Erikssen G, Liestol K, Gullestad L, et al. The terminal part of the QT interval (T peak to T end): a predictor of mortality after acute myocardial infarction. Ann Noninvasive Electrocardiol. 2012;17(2):85-94.
  • Karakayalı M, Artac I, Ilis D, et al. Evaluation of Symptomatic and Asymptomatic Outpatients in the Post-COVID-19 Period With Electrocardiographic Ventricular Depolarization and Repolarization Parameters. Int J Cardiovasc Sci. 2024;37.
  • Çağdaş M, Karakoyun S, Rencüzoğulları İ, et al. Assessment of the relationship between reperfusion success and T-peak to T-end interval in patients with ST elevation myocardial infarction treated with percutaneous coronary intervention. Anatol J Cardiol. 2018;19(1):50-7.
  • Gupta P, Patel C, Patel H, et al. T(p-e)/QT ratio as an index of arrhythmogenesis. J Electrocardiol. 2008;41(6):567-74.
  • Seiler C, Kirkeeide RL, Gould KL. Measurement from arteriograms of regional myocardial bed size distal to any point in the coronary vascular tree for assessing anatomic area at risk. J Am Coll Cardiol. 1993;21(3):783 –97.
  • Graham MM, Faris PD, Ghali WA, et al. Validation of three myocardial jeopardy scores in a population-based cardiac catheterization cohort. Am Heart J. 2001;142(2):254–61.
  • Ortiz-Pe´rez JT, Meyers SN, Lee DC, et al. Angiographic estimates of myocardium at risk during acute myocardial infarction: validation study using cardiac magnetic resonance imaging. European Heart J. 2007;28(14):1750–8.
  • Arbustini E, Kramer C M, Narula J. Arrhythmogenic potential of border zone after myocardial infarction. JACC: Cardiovasc. Imaging 2018;11, 573–6.
  • Oknińska M, Mączewski M, Mackiewicz U. Ventricular arrhythmias in acute myocardial ischemia-Focus on the ageing and sex. Ageing Res Rev. 2022;81:1017-22.
  • Thomsen AF, Jons C, Jabbari R, et al. Long-term risk of new-onset arrhtmia in ST-segment elevation myocardial infarction according to revascularization status. Europace. 2023;25(3): 931-9.
  • Li D, Weng Y, Zhen G, et al. Tp-Te Interval and Tp-Te/QT Ratio Are Valuable Tools in Predicting Poor Outcome in Sepsis Patients. Front Cardiovasc Med. 2022;23(9):879-85.
  • Tashiro N, Muneuchi J, Ezaki H, et al. Ventricular Repolarization Dispersion is a Potential Risk for the Development of Life-Threatening Arrhythmia in Children with Hypertrophic Cardiomyopathy. Pediatr Cardiol. 2022;43(7):1455-61.
  • Karacop E, Karacop HB. Correlation between apnea-hypopnea index and Tp-Te interval, Tp-Te/QT, and Tp-Te/QTc ratios in obstructive sleep apnea. Ann Noninvasive Electrocardiol. 2021;26(2):1280-9.
  • Bendary A, Abdallah A, Elemary M, et al. Predictive Value of Tpeak-to-Tend/QT for Early Ventricular Arrhythmias and Arrhythmogenic Death in Patients with Anterior ST Elevation Myocardial Infarction. Ann Cardiol Angeiol (Paris). 2024;73(6):1018-40.
  • Juki A, Carevi V, Zekanovi D, et al. Impact of percutaneous coronary intervention on exercise-induced repolarization changes in patients with stable coronary artery disease. Am J Cardiol. 2015;116(6):853-7.
  • Carrizo S, Peinado R, Sanchez-Recalde A, et al. Clinical and angiographic characteristics of patients with acute coronary syndrome associated with sudden cardiac death. Hellenic J Cardiol. 2015;56(2):136-41.
  • Kwofie MA, Chaudhary AK, Martins JB. Association among intracardiac T-wave alternans, ischemia, and spontaneous ventricular arrhythmias after coronary artery occlusion in a canine model. Transl Res. 2011;158(5):265-72.
  • Petousis S, Hamilos M, Pagonidis K, et al. Assessment of myocardial salvage in patients with STEMI undergoing thrombolysis: ticagrelor versus clopidogrel. BMC Cardiovasc Disord. 2022;22(1):301.
  • De Palma R, Sorensson P, Verouhis D, et al. Quantification of myocardium at risk in ST- elevation myocardial infarction: a comparison of contrast-enhanced steady-state free precession cine cardiovascular magnetic resonance with coronary angiographic jeopardy scores. J Cardiovasc Magn Reson. 2017;19(1):55-65.

Miyokart İskemisi Olan Kararlı Koroner Arter Hastalarında Lezyon Lokalizasyonunun ve İskemik Miyokart Kitlesi Büyüklüğünün Aritmi Parametreleri ile Değerlendirilmesi

Year 2025, Volume: 12 Issue: 2, 105 - 112, 28.08.2025
https://doi.org/10.47572/muskutd.1610666

Abstract

Kararlı koroner arter hastalığında, hangi koroner arterdeki kritik darlığın daha aritmik olduğunu ve darlık bulunan arterin mi yoksa darlığa bağlı iskemi altında kalan miyokart dokusunun büyüklüğünün mü malign ventriküler aritmiler açısından daha önemli olduğunu elektrokardiyografi üzerinde hesaplanan aritmi öngördürücüleri yardımıyla değerlendirmektir. Çalışmamız retrospektif gözlemsel çalışma olarak tasarlanmıştır. Ocak 2013-2016 tarihleri arasında koroner anjiyografisinde tek damar hastalığı saptanmış ve bu damara perkütan koroner girişim uygulanmış 183 hasta incelendi. Girişim öncesi ve sonrası çekilen elektrokardiyografilerde aritmi öngördürücülerinden TpTe intervali, QTc intervali ve TpTe/QT oranı hesaplandı. İskemi altındaki miyokart dokusu yüzdesi APPROACH skoru kullanılarak, koroner anjiyografi görüntüleri yardımı ile hesaplandı. Sol ön inen arter lezyonlarının iskemi altında bıraktığı sol ventrikül miyokart dokusu yüzdesinin (34±10); sirkumflex arter (17±11) ve sağ koroner arter (21±5)’in iskemi altında bıraktığı miyokart dokusu yüzdelerinden anlamlı bir şekilde fazla olduğu görüldü (p<0.001). Perkütan koroner girişim öncesi ve sonrası TpTe intervali ve TpTe/QT oranı farkı sol ön inen arter lezyonu olan grupta sirkumflex arter ve sağ koroner arter lezyonu olan gruplardan anlamlı bir şekilde yüksek bulundu (p<0.001). Kararlı koroner arter hastalığında, iskemik miyokart büyüklüğü arttıkça aritmojenitenin artabileceği saptandı. Elektrokardiyografi üzerinden hesaplanan aritmi parametreleri açısından revaskülarizasyondan en fazla fayda görebilecek grubun kritik sol ön inen arter darlığına sahip kararlı koroner arter hastaları olduğu görüldü.

References

  • Vrints C, Andreotti F, Koskinas KC et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024;45(36):3415-537.
  • Chockalignam A, Balaguer-Vintro, Achutti A, et al. Impending global pandemic of cardiovascular diseases; challenges and opportunities for the prevention and control of cardiovascular diseases in developing countries and economies in transition. Can J Cardiol. 2000;16(2):231-5.
  • Gach O, Davin L, Lempereur M, et al. Diagnostic coronarography. Rev Med Liege. 2019;74(1):17-21.
  • Erikssen G, Liestol K, Gullestad L, et al. The terminal part of the QT interval (T peak to T end): a predictor of mortality after acute myocardial infarction. Ann Noninvasive Electrocardiol. 2012;17(2):85-94.
  • Karakayalı M, Artac I, Ilis D, et al. Evaluation of Symptomatic and Asymptomatic Outpatients in the Post-COVID-19 Period With Electrocardiographic Ventricular Depolarization and Repolarization Parameters. Int J Cardiovasc Sci. 2024;37.
  • Çağdaş M, Karakoyun S, Rencüzoğulları İ, et al. Assessment of the relationship between reperfusion success and T-peak to T-end interval in patients with ST elevation myocardial infarction treated with percutaneous coronary intervention. Anatol J Cardiol. 2018;19(1):50-7.
  • Gupta P, Patel C, Patel H, et al. T(p-e)/QT ratio as an index of arrhythmogenesis. J Electrocardiol. 2008;41(6):567-74.
  • Seiler C, Kirkeeide RL, Gould KL. Measurement from arteriograms of regional myocardial bed size distal to any point in the coronary vascular tree for assessing anatomic area at risk. J Am Coll Cardiol. 1993;21(3):783 –97.
  • Graham MM, Faris PD, Ghali WA, et al. Validation of three myocardial jeopardy scores in a population-based cardiac catheterization cohort. Am Heart J. 2001;142(2):254–61.
  • Ortiz-Pe´rez JT, Meyers SN, Lee DC, et al. Angiographic estimates of myocardium at risk during acute myocardial infarction: validation study using cardiac magnetic resonance imaging. European Heart J. 2007;28(14):1750–8.
  • Arbustini E, Kramer C M, Narula J. Arrhythmogenic potential of border zone after myocardial infarction. JACC: Cardiovasc. Imaging 2018;11, 573–6.
  • Oknińska M, Mączewski M, Mackiewicz U. Ventricular arrhythmias in acute myocardial ischemia-Focus on the ageing and sex. Ageing Res Rev. 2022;81:1017-22.
  • Thomsen AF, Jons C, Jabbari R, et al. Long-term risk of new-onset arrhtmia in ST-segment elevation myocardial infarction according to revascularization status. Europace. 2023;25(3): 931-9.
  • Li D, Weng Y, Zhen G, et al. Tp-Te Interval and Tp-Te/QT Ratio Are Valuable Tools in Predicting Poor Outcome in Sepsis Patients. Front Cardiovasc Med. 2022;23(9):879-85.
  • Tashiro N, Muneuchi J, Ezaki H, et al. Ventricular Repolarization Dispersion is a Potential Risk for the Development of Life-Threatening Arrhythmia in Children with Hypertrophic Cardiomyopathy. Pediatr Cardiol. 2022;43(7):1455-61.
  • Karacop E, Karacop HB. Correlation between apnea-hypopnea index and Tp-Te interval, Tp-Te/QT, and Tp-Te/QTc ratios in obstructive sleep apnea. Ann Noninvasive Electrocardiol. 2021;26(2):1280-9.
  • Bendary A, Abdallah A, Elemary M, et al. Predictive Value of Tpeak-to-Tend/QT for Early Ventricular Arrhythmias and Arrhythmogenic Death in Patients with Anterior ST Elevation Myocardial Infarction. Ann Cardiol Angeiol (Paris). 2024;73(6):1018-40.
  • Juki A, Carevi V, Zekanovi D, et al. Impact of percutaneous coronary intervention on exercise-induced repolarization changes in patients with stable coronary artery disease. Am J Cardiol. 2015;116(6):853-7.
  • Carrizo S, Peinado R, Sanchez-Recalde A, et al. Clinical and angiographic characteristics of patients with acute coronary syndrome associated with sudden cardiac death. Hellenic J Cardiol. 2015;56(2):136-41.
  • Kwofie MA, Chaudhary AK, Martins JB. Association among intracardiac T-wave alternans, ischemia, and spontaneous ventricular arrhythmias after coronary artery occlusion in a canine model. Transl Res. 2011;158(5):265-72.
  • Petousis S, Hamilos M, Pagonidis K, et al. Assessment of myocardial salvage in patients with STEMI undergoing thrombolysis: ticagrelor versus clopidogrel. BMC Cardiovasc Disord. 2022;22(1):301.
  • De Palma R, Sorensson P, Verouhis D, et al. Quantification of myocardium at risk in ST- elevation myocardial infarction: a comparison of contrast-enhanced steady-state free precession cine cardiovascular magnetic resonance with coronary angiographic jeopardy scores. J Cardiovasc Magn Reson. 2017;19(1):55-65.
There are 22 citations in total.

Details

Primary Language English
Subjects Clinical Sciences (Other)
Journal Section Original Article
Authors

Fatih Erkam Olgun 0000-0002-8428-9694

Filiz Kızılırmak Yılmaz 0000-0003-1919-3183

Tayyar Gökdeniz 0000-0001-5345-2359

Gültekin Günhan Demır 0000-0001-9975-5507

Ersin Ibısoglu 0000-0002-1231-0933

Ümeyir Savur 0000-0003-1320-9033

Deniz Dilan Naki Tekin 0000-0002-0113-9907

Hacı Murat Güneş 0000-0001-5825-8627

Beytullah Cakal 0000-0003-0230-6575

İbrahim Oğuz Karaca 0000-0002-4281-0867

Fethi Kılıçaslan 0000-0003-2459-2445

Bilal Boztosun 0000-0002-4951-6716

Publication Date August 28, 2025
Submission Date December 31, 2024
Acceptance Date April 30, 2025
Published in Issue Year 2025 Volume: 12 Issue: 2

Cite

APA Olgun, F. E., Kızılırmak Yılmaz, F., Gökdeniz, T., … Demır, G. G. (2025). The Evaluation of Lesion Localization and Ischemic Myocardial Mass Via Arrhythmia Parameters in Stable Coronary Artery Patients with Myocardial Ischemia. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi, 12(2), 105-112. https://doi.org/10.47572/muskutd.1610666
AMA Olgun FE, Kızılırmak Yılmaz F, Gökdeniz T, et al. The Evaluation of Lesion Localization and Ischemic Myocardial Mass Via Arrhythmia Parameters in Stable Coronary Artery Patients with Myocardial Ischemia. MMJ. August 2025;12(2):105-112. doi:10.47572/muskutd.1610666
Chicago Olgun, Fatih Erkam, Filiz Kızılırmak Yılmaz, Tayyar Gökdeniz, Gültekin Günhan Demır, Ersin Ibısoglu, Ümeyir Savur, Deniz Dilan Naki Tekin, et al. “The Evaluation of Lesion Localization and Ischemic Myocardial Mass Via Arrhythmia Parameters in Stable Coronary Artery Patients With Myocardial Ischemia”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 12, no. 2 (August 2025): 105-12. https://doi.org/10.47572/muskutd.1610666.
EndNote Olgun FE, Kızılırmak Yılmaz F, Gökdeniz T, Demır GG, Ibısoglu E, Savur Ü, Naki Tekin DD, Güneş HM, Cakal B, Karaca İO, Kılıçaslan F, Boztosun B (August 1, 2025) The Evaluation of Lesion Localization and Ischemic Myocardial Mass Via Arrhythmia Parameters in Stable Coronary Artery Patients with Myocardial Ischemia. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 12 2 105–112.
IEEE F. E. Olgun et al., “The Evaluation of Lesion Localization and Ischemic Myocardial Mass Via Arrhythmia Parameters in Stable Coronary Artery Patients with Myocardial Ischemia”, MMJ, vol. 12, no. 2, pp. 105–112, 2025, doi: 10.47572/muskutd.1610666.
ISNAD Olgun, Fatih Erkam et al. “The Evaluation of Lesion Localization and Ischemic Myocardial Mass Via Arrhythmia Parameters in Stable Coronary Artery Patients With Myocardial Ischemia”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 12/2 (August2025), 105-112. https://doi.org/10.47572/muskutd.1610666.
JAMA Olgun FE, Kızılırmak Yılmaz F, Gökdeniz T, Demır GG, Ibısoglu E, Savur Ü, Naki Tekin DD, Güneş HM, Cakal B, Karaca İO, Kılıçaslan F, Boztosun B. The Evaluation of Lesion Localization and Ischemic Myocardial Mass Via Arrhythmia Parameters in Stable Coronary Artery Patients with Myocardial Ischemia. MMJ. 2025;12:105–112.
MLA Olgun, Fatih Erkam et al. “The Evaluation of Lesion Localization and Ischemic Myocardial Mass Via Arrhythmia Parameters in Stable Coronary Artery Patients With Myocardial Ischemia”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi, vol. 12, no. 2, 2025, pp. 105-12, doi:10.47572/muskutd.1610666.
Vancouver Olgun FE, Kızılırmak Yılmaz F, Gökdeniz T, Demır GG, Ibısoglu E, Savur Ü, et al. The Evaluation of Lesion Localization and Ischemic Myocardial Mass Via Arrhythmia Parameters in Stable Coronary Artery Patients with Myocardial Ischemia. MMJ. 2025;12(2):105-12.