Association between SYNTAX II score and Index of electrophysiological balance in patients with stable angina pectoris

Abstract

Background/Aim: Syntax II scoring system has been established by integrating anatomical features and clinical characteristics of patients in order to achieve better prediction of post-procedural outcomes. On the other hand, its predictive value for the occurrence of life-threatening arrhythmias is inconclusive. Index of cardio electrophysiological balance (iCEB) serve as an ECG based derivative of cardiac wave length and associated with torsades de pointes (TdP) and nontorsadogenic ventricular tachycardia (VT) or ventricular fibrillation (VF). In this study we aimed to investigate the prognostic value of SYNTAX II scoring system for predicting malignant ventricular arrhythmias by using iCEB. Methods: 297 patients undergoing coronary angiography (CAG) were included in the retrospective cohort study. Patients were divided into two groups based on their calculated SYNTAX Score II. For each group, ECG parameters including heart rate (b.p.m.), QRS interval (ms), QT interval (ms), corrected QT (QTC) interval (ms), QTc difference (V1-V6), QT/QRS ratio (iCEB) and QTC/QRS ratio (iCEBc) were analyzed. Results: According to our study estimated QRS, QT and QTc intervals were signifciantly higher in patients with calculated SYNTAX S II >26 as compared to patients with calculated SYNTAX S II ≤26 (respectively; P=0.001, P=0.014 and P=0.001). In addition, estimated QT/QRS (iECB) and QTc/QRS (iECBc) ratio were significantly lower in patients with calculated SYNTAX S II >26 as compared to those with calculated SYNTAX S II ≤26 (respectively; P=0.002 and P=0.005). Conclusion: Our data showed that, there was a strong association between QTC, iECB, iECBc and SYNTAX Score II. Therefore, the SYNTAX Score II might be considered as an important tool to predict malignant ventricular arrhythmias.

Keywords

• SYNTAX Score II
• Index of cardio electrophysiological balance
• Electrocardiography

Kaynakça

1. 1. Ong AT, Serruys PW, Mohr FW, Morice MC, Kappetein AP, Holmes DR Jr, et al. The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) study: design, rationale, and run-in phase. Am Heart J. 2006 Jun;151(6):1194-204. doi: 10.1016/j.ahj.2005.07.017. PMID: 16781219.
2. 2. Minamisawa M, Miura T, Motoki H, Kobayashi H, Kobayashi M, Nakajima H, et al; SHINANO Registry Investigators. Prediction of 1-year clinical outcomes using the SYNTAX score in patients with prior heart failure undergoing percutaneous coronary intervention: sub-analysis of the SHINANO registry. Heart Vessels. 2017 Apr;32(4):399-407. doi: 10.1007/s00380-016-0896-9. Epub 2016 Oct 5. PMID: 27709325; PMCID: PMC5371627.
3. 3. Serruys PW, Onuma Y, Garg S, Sarno G, van den Brand M, Kappetein AP, et al. Assessment of the SYNTAX score in the Syntax study. EuroIntervention. 2009 May;5(1):50-6. doi: 10.4244/eijv5i1a9. PMID: 19577983.
4. 4. Farooq V, van Klaveren D, Steyerberg EW, Meliga E, Vergouwe Y, Chieffo A, et al. Anatomical and clinical characteristics to guide decision making between coronary artery bypass surgery and percutaneous coronary intervention for individual patients: development and validation of SYNTAX score II. Lancet. 2013 Feb 23;381(9867):639-50. doi: 10.1016/S0140-6736(13)60108-7. PMID: 23439103.
5. 5. Lu HR, Yan GX, Gallacher DJ. A new biomarker--index of cardiac electrophysiological balance (iCEB)--plays an important role in drug-induced cardiac arrhythmias: beyond QT-prolongation and Torsades de Pointes (TdPs). J Pharmacol Toxicol Methods. 2013 Sep-Oct;68(2):250-259. doi: 10.1016/j.vascn.2013.01.003. Epub 2013 Jan 19. PMID: 23337247.
6. 6. Robyns T, Lu HR, Gallacher DJ, Garweg C, Ector J, Willems R, et al. Evaluation of Index of Cardio-Electrophysiological Balance (iCEB) as a New Biomarker for the Identification of Patients at Increased Arrhythmic Risk. Ann Noninvasive Electrocardiol. 2016 May;21(3):294-304. doi: 10.1111/anec.12309. Epub 2015 Aug 25. PMID: 26305685; PMCID: PMC6931457.
7. 7. Kligfield P, Gettes LS, Bailey JJ, et al. Recommendations for the standardization and interpretation of the electrocardiogram: part I: The electrocardiogram and its technology: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society: endorsed by the International Society for Computerized Electrocardiology. Circulation. 2007 Mar 13;115(10):1306-24. doi: 10.1161/CIRCULATIONAHA.106.180200.
8. 8. Goldenberg I, Moss AJ, Zareba W. QT interval: how to measure it and what is "normal". J Cardiovasc Electrophysiol. 2006 Mar;17(3):333-6. doi: 10.1111/j.1540-8167.2006.00408.x. PMID: 16643414.

9. 9. Campos CM, van Klaveren D, Farooq V, Simonton CA, Kappetein AP, Sabik JF 3rd, et al; EXCEL Trial Investigators. Long-term forecasting and comparison of mortality in the Evaluation of the Xience Everolimus Eluting Stent vs. Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial: prospective validation of the SYNTAX Score II. Eur Heart J. 2015 May 21;36(20):1231-41. doi: 10.1093/eurheartj/ehu518. Epub 2015 Jan 12. PMID: 25583761.
10. 10. Chen J, Tang B, Lin Y, Ru Y, Wu M, Wang X, et al. Validation of the Ability of SYNTAX and Clinical SYNTAX Scores to Predict Adverse Cardiovascular Events After Stent Implantation: A Systematic Review and Meta-Analysis. Angiology. 2016 Oct;67(9):820-8. doi: 10.1177/0003319715618803. Epub 2015 Nov 26. PMID: 26614789.
11. 11. Song Y, Gao Z, Tang X, Ma Y, Jiang P, Xu J, et al. Usefulness of the SYNTAX score II to validate 2-year outcomes in patients with complex coronary artery disease undergoing percutaneous coronary intervention: A large single-center study. Catheter Cardiovasc Interv. 2018 Jul;92(1):40-7. doi: 10.1002/ccd.27321. Epub 2017 Sep 12. PMID: 28895284.
12. 12. Rencuzogullari I, Çağdaş M, Karakoyun S, Yesin M, Gürsoy MO, Artaç İ, et al. Propensity score matching analysis of the impact of Syntax score and Syntax score II on new onset atrial fibrillation development in patients with ST segment elevation myocardial infarction. Ann Noninvasive Electrocardiol. 2018 Mar;23(2):e12504. doi: 10.1111/anec.12504. Epub 2017 Oct 4. PMID: 28975725; PMCID: PMC6931703.
13. 13. Yumurtacı O, Kurt C, Ucar MF, O Cihan. Usefulness Of Electrocardiographic Markers To Predict Ventricular Arrhythmias In Acute Myocarditis Patients. Turkish Med. Stud. J. 2017;4:6-10. doi: 10.4274/tmsj.2017.04.01.0002
14. 14. Nafakhi H, Al-Mosawi AA, Alareedh M, Al-Nafakh HA. Index of cardiac electrophysiological balance and transmural dispersion of the repolarization index relationships with pericardial fat volume and coronary calcification. Biomark Med. 2018 Apr;12(4):321-28. doi: 10.2217/bmm-2017-0187. Epub 2018 Mar 8. PMID: 29517280.
15. 15. Chistiakov DA, Grechko AV, Myasoedova VA, Melnichenko AA, Orekhov AN. Impact of the cardiovascular system-associated adipose tissue on atherosclerotic pathology. Atherosclerosis. 2017 Aug;263:361-8. doi: 10.1016/j.atherosclerosis.2017.06.017. Epub 2017 Jun 8. PMID: 28629772.
16. 16. Wong CX, Ganesan AN, Selvanayagam JB. Epicardial fat and atrial fibrillation: current evidence, potential mechanisms, clinical implications, and future directions. Eur Heart J. 2017 May 1;38(17):1294-302. doi: 10.1093/eurheartj/ehw045. PMID: 26935271.
17. 17. Goudis CA, Vasileiadis IE, Liu T. Epicardial adipose tissue and atrial fibrillation: pathophysiological mechanisms, clinical implications, and potential therapies. Curr Med Res Opin. 2018 Nov;34(11):1933-43. doi: 10.1080/03007995.2018.1462786. Epub 2018 May 3. PMID: 29625530.