Relationship between frontal QRS-T angle and coronary slow flow phenomenon

Yıl 2021, Cilt: 5 Sayı: 2, 174 - 178, 01.02.2021

Sinan Cemgil Özbek

https://doi.org/10.28982/josam.754698

Öz

Background/Aim: Coronary slow flow phenomenon (CSFP) is termed as slow passage of contrast dye to distal portion of the coronary arteries, and can provoke angina pectoris, serious arrhythmias, or even sudden death. Previous reports suggested that frontal QRS-T angle (fQRSTa), measured by surface ECG may associate with ventricular arrhythmias and cardiac death. In this study, we aimed to assess the relationship between fQRSTa and CSFP.
Methods: In this case-control study, we retrospectively included 76 patients with CSFP [85.5% male; mean age 58.4 (9.2) years] and 50 patients with normal coronary flow (control group) [86.6% male; mean age 56.5 (10.1) years] between July 2017 and March 2019. CSFP was identified by TIMI frame count (TFC) method. Demographic, clinical and ECG characteristics were obtained from hospital records.
Results: The groups were similar concerning co-morbid cardiac conditions. Mean QTc interval and median fQRSTa were significantly greater in CSFP group compared with the controls [416.2 (34.5) vs 401 (36.3), P=0.020 and 51° (11° to 132°) vs 27° (4° to 92°), P<0.001; respectively].
Conclusion: The findings may suggest a possible distortion in cardiac electrical micropathways and indicate an increased likelihood of arrhythmia.

Anahtar Kelimeler

Coronary Slow Flow Phenomenon, Frontal QRS-T Angle, arrithmia

Kaynakça

• 1. Tambe AA, Demany MA, Zimmerman HA, Mascarenhas E. Angina pectoris and slow flow velocity of dye in coronary arteries--a new angiographic finding. Am Heart J. 1972;84(1):66-71. doi:10.1016/0002-8703(72)90307-9
• 2. Beltrame JF, Limaye SB, Horowitz JD. The coronary slow flow phenomenon--a new coronary microvascular disorder. Cardiology. 2002;97(4):197-202. doi:10.1159/000063121
• 3. Diver DJ, Bier JD, Ferreira PE, Sharaf BL, McCabe C, Thompson B, et al. Clinical and arteriographic characterization of patients with unstable angina without critical coronary arterial narrowing (from the TIMI-IIIA Trial). Am J Cardiol. 1994;74(6):531-7. doi:10.1016/0002-9149(94)90739-0
• 4. Hawkins BM, Stavrakis S, Rousan TA, Abu-Fadel M, Schechter E. Coronary slow flow--prevalence and clinical correlations. Circulation journal : official journal of the Japanese Circulation Society. 2012;76(4):936-42. doi:10.1253/circj.CJ-11-0959
• 5. Wozakowska-Kaplon B, Niedziela J, Krzyzak P, Stec S. Clinical manifestations of slow coronary flow from acute coronary syndrome to serious arrhythmias. Cardiol J. 2009;16(5):462-8.
• 6. Suner A, Cetin M. The effect of trimetazidine on ventricular repolarization indexes and left ventricular diastolic function in patients with coronary slow flow. Coronary artery disease. 2016;27(5):398-404. doi:10.1097/MCA.0000000000000373
• 7. Amasyali B, Turhan H, Kose S, Celik T, Iyisoy A, Kursaklioglu H, Isik E. Aborted sudden cardiac death in a 20-year-old man with slow coronary flow. Int J Cardiol. 2006;109(3):427-9. doi: 10.1016/j.ijcard.2005.06.044
• 8. Sucu M, Ucaman B, Ozer O, Altas Y, Polat E. Novel Ventricular Repolarization Indices in Patients with Coronary Slow Flow. Journal of atrial fibrillation. 2016;9(3):1446. doi: 10.4022/jafib.1446
• 9. Eshraghi A, Hoseinjani E, Jalalyazdi M, Vojdanparast M, Jafarzadeh-Esfehani R. QT interval and P wave dispersion in slow coronary flow phenomenon. ARYA atherosclerosis. 2018;14(5):212-7. doi: 10.22122/arya.v14i5.1599
• 10. Karaman K, Altunkas F, Cetin M, Karayakali M, Arisoy A, Akar I et al. New markers for ventricular repolarization in coronary slow flow: Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio. Ann Noninvasive Electrocardiol. 2015;20(4):338-44. doi:10.1111/anec.12203
• 11. Aro AL, Huikuri HV, Tikkanen JT, Junttila MJ, Rissanen HA, Reunanen A, Anttonen O. QRS-T angle as a predictor of sudden cardiac death in a middle-aged general population. Europace: European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 2012;14(6):872-6. doi:10.1093/europace/eur393
• 12. Zhang ZM, Prineas RJ, Case D, Soliman EZ, Rautaharju PM. Comparison of the prognostic significance of the electrocardiographic QRS/T angles in predicting incident coronary heart disease and total mortality (from the atherosclerosis risk in communities study). Am J Cardiol. 2007;100(5):844-9. doi: 10.1016/j.amjcard.2007.03.104
• 13. May O, Graversen CB, Johansen MO, Arildsen H. The prognostic value of the frontal QRS-T angle is comparable to cardiovascular autonomic neuropathy regarding long-term mortality in people with diabetes. A population based study. Diabetes research and clinical practice. 2018;142:264-8. doi:10.1016/j.diabres.2018.05.018
• 14. Oehler A, Feldman T, Henrikson CA, Tereshchenko LG. QRS-T angle: a review. Ann Noninvasive Electrocardiol. 2014;19(6):534-42. doi:10.1111/anec.12206
• 15. Gibson CM, Cannon CP, Daley WL, Dodge JT, Jr., Alexander B, Jr., Marble SJ, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996;93(5):879-88. doi: 10.1161/01.CIR.93.5.879
• 16. Sanghvi S, Mathur R, Baroopal A, Kumar A. Clinical, demographic, risk factor and angiographic profile of coronary slow flow phenomenon: A single centre experience. Indian Heart J. 2018;70 Suppl 3:S290-s4. doi:10.1016/j.ihj.2018.06.001
• 17. Castro-Torres Y, Carmona-Puerta R, Katholi RE. Ventricular repolarization markers for predicting malignant arrhythmias in clinical practice. World J Clin Cases. 2015;3(8):705-20. doi: 10.12998/wjcc.v3.i8.705
• 18. Bazett H. An analysis of the time relations of electrocardiograms. Heart 7:353-370. 1920.
• 19. Tanriverdi Z, Unal B, Eyuboglu M, Bingol Tanriverdi T, Nurdag A, Demirbag R. The importance of frontal QRS-T angle for predicting non-dipper status in hypertensive patients without left ventricular hypertrophy. Clin Exp Hypertens. 2018;40(4):318-23. doi:10.1080/10641963.2017.1377214
• 20. Kurisu S, Nitta K, Sumimoto Y, Ikenaga H, Ishibashi K, Fukuda Y, Kihara Y. Effects of deep inspiration on QRS axis, T-wave axis and frontal QRS-T angle in the routine electrocardiogram. Heart Vessels. 2019. doi:10.1007/s00380-019-01380-7
• 21. Lazzeroni D, Bini M, Camaiora U, Castiglioni P, Moderato L, Ugolotti PT, et al. Prognostic value of frontal QRS-T angle in patients undergoing myocardial revascularization or cardiac valve surgery. J Electrocardiol. 2018;51(6):967-72. doi: 10.1016/j.jelectrocard.2018.08.028
• 22. Goel PK, Gupta SK, Agarwal A, Kapoor A. Slow coronary flow: a distinct angiographic subgroup in syndrome X. Angiology. 2001;52(8):507-14. doi:10.1177/000331970105200801
• 23. Selcuk MT, Selcuk H, Temizhan A, Maden O, Ulupinar H, Baysal E, et al.. Asymmetric dimethylarginine plasma concentrations and L-arginine/asymmetric dimethylarginine ratio in patients with slow coronary flow. Coronary artery disease. 2007;18(7):545-51. doi: 10.1097/MCA.0b013e3282eff1c6
• 24. Sezgin N, Barutcu I, Sezgin AT, Gullu H, Turkmen M, Esen AM, Karakaya O. Plasma nitric oxide level and its role in slow coronary flow phenomenon. International heart journal. 2005;46(3):373-82. doi:10.1536/ihj.46.373
• 25. Mosseri M, Yarom R, Gotsman MS, Hasin Y. Histologic evidence for small-vessel coronary artery disease in patients with angina pectoris and patent large coronary arteries. Circulation. 1986;74(5):964-72. doi: 10.1161/01.CIR.74.5.964
• 26. Mangieri E, Macchiarelli G, Ciavolella M, Barilla F, Avella A, Martinotti A, et al. Slow coronary flow: clinical and histopathological features in patients with otherwise normal epicardial coronary arteries. Cathet Cardiovasc Diagn. 1996;37(4):375-81. doi:10.1002/(SICI)1097-0304(199604)37:4<375::AID-CCD7>3.0.CO;2-8
• 27. Pekdemir H, Cin VG, Cicek D, Camsari A, Akkus N, Doven O, Parmaksiz HT. Slow coronary flow may be a sign of diffuse atherosclerosis. Contribution of FFR and IVUS. Acta cardiologica. 2004;59(2):127-33.
• 28. Yilmaz H, Gungor B, Kemaloglu T, Sayar N, Erer B, Yilmaz M, et al. The presence of fragmented QRS on 12-lead ECG in patients with coronary slow flow. Kardiol Pol. 2014;72(1):14-9. doi:10.5603/KP.2013.0181
• 29. Atak R, Turhan H, Sezgin AT, Yetkin O, Senen K, Ileri M, et al. Effects of slow coronary artery flow on QT interval duration and dispersion. Ann Noninvasive Electrocardiol. 2003;8(2):107-11. doi:10.1046/j.1542-474X.2003.08203.x
• 30. Sezgin AT, Barutcu I, Ozdemir R, Gullu H, Topal E, Esen AM, et al. Effect of slow coronary flow on electrocardiographic parameters reflecting ventricular heterogeneity. Angiology. 2007;58(3):289-94. doi:10.1177/0003319707302486
• 31. Li G, Zhang L. The role of mexiletine in the management of long QT syndrome. J Electrocardiol. 2018;51(6):1061-5. doi: 10.1016/j.jelectrocard.2018.08.035
• 32. Chua KC, Teodorescu C, Reinier K, Uy-Evanado A, Aro AL, Nair SG, et al. Wide QRS-T Angle on the 12-Lead ECG as a Predictor of Sudden Death Beyond the LV Ejection Fraction. J Cardiovasc Electrophysiol. 2016;27(7):833-9. doi:10.1111/jce.12989
• 33. Scherptong RW, Henkens IR, Man SC, Le Cessie S, Vliegen HW, Draisma HH, et al. Normal limits of the spatial QRS-T angle and ventricular gradient in 12-lead electrocardiograms of young adults: dependence on sex and heart rate. J Electrocardiol. 2008;41(6):648-55. doi: 10.1016/j.jelectrocard.2008.07.006
• 34. Draisma HH, Schalij MJ, van der Wall EE, Swenne CA. Elucidation of the spatial ventricular gradient and its link with dispersion of repolarization. Heart rhythm. 2006;3(9):1092-9. doi: 10.1016/j.hrthm.2006.05.025
• 35. Saya S, Hennebry TA, Lozano P, Lazzara R, Schechter E. Coronary slow flow phenomenon and risk for sudden cardiac death due to ventricular arrhythmias: a case report and review of literature. Clin Cardiol. 2008;31(8):352-5. doi:10.1002/clc.20266
• 36. Gungor M, Celik M, Yalcinkaya E, Polat AT, Yuksel UC, Yildirim E, et al. The Value of Frontal Planar QRS-T Angle in Patients without Angiographically Apparent Atherosclerosis. Medical principles and practice : international journal of the Kuwait University, Health Science Centre. 2017;26(2):125-31. doi:10.1159/000453267
• 37. Kuyumcu M. S., Özbay M. B., Özen Y.,Yayla Ç. Evaluation of frontal plane QRS-T angle in patients with slow coronary flow. Scandinavian Cardiovascular Journal. 2019 29:1-6. doi:10.1080/14017431.2019.1682655