Yıl: 2019 Cilt: 22 Sayı: 4 Sayfa Aralığı: 194 - 201 Metin Dili: İngilizce DOI: 10.14744/AnatolJCardiol.2019.99692 İndeks Tarihi: 17-06-2020

Frontal QRS-T angle is related with hemodynamic significance of coronary artery stenosis in patients with single vessel disease

Öz:
Objective: Fractional flow reserve (FFR) measurement is used to decide the hemodynamic significance of coronary artery lesion. QRS-T angle (QRSTa) is a novel marker of myocardial repolarization abnormality and is affected by obstructive coronary artery disease. The aim of the present study was to evaluate the association between QRSTa and coronary FFR measurement in patients with isolated left anterior descending (LAD) artery stenosis.Methods: A total of 197 patients undergoing FFR measurement for isolated LAD artery stenosis were retrospectively enrolled in the present study. According to FFR value, patients were divided into two groups as 139 patients with normal FFR (>0.80, group 1) and 58 patients with low FFR (≤0.80, group 2). A 12-lead surface electrocardiography of all subjects that had been recorded before performing coronary angiography was evaluated to measure QRSTa, as well as baseline demographic and clinical variables.Results: The mean age of group 2 was significantly higher than that of group 1 (61±11 and 64±11, p=0.044). While there were no differences in heart rate, QRS duration, and corrected QT interval between the two groups, QT interval [377 (359–397) and 379 (367–410), p=0.045] and frontal QRSTa [59 (10–120) and 86 (22–132), p<0.001] were higher in group 2. QT interval [odds ratio (OR)=1.046, 95% confidence interval (CI)=1.010–1.084, p=0.012] and frontal QRSTa (OR=1.025, 95% CI=1.010–1.041, p=0.001) were found to be independent predictors of low FFR value in multivariate logistic regression analysis.Conclusion: In the present study, FFR measurement was demonstrated to be correlated with wide QRSTa as a noninvasive and easy method. Thus, we suggest that the results of FFR measurement as an invasive modality can be previously predicted with a simple electrocardiographic evaluation, such as QRSTa. (Anatol J Cardiol 2019; 22: 194-201)
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  • 1. Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al.; ESC Scientific Document Group. 2018 ESC/ EACTS Guidelines on myocardial revascularization. Eur Heart J 2019; 40: 87-165.
  • 2. De Bruyne B, Pijls NH, Kalesan B, Barbato E, Tonino PA, Piroth Z, et al.; FAME 2 Trial Investigators. Fractional flow reserve-guided PCI vs. medical therapy in stable coronary disease. N Engl J Med 2012; 367: 991-1001.
  • 3. Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van' t Veer M, et al.; FAME Study Investigators. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 2009; 360: 213-24.
  • 4. Oehler A, Feldman T, Henrikson CA, Tereshchenko LG. QRS-T angle: a review. Ann Noninvasive Electrocardiol 2014; 19: 534-42.
  • 5. Giannopoulos G, Dilaveris P, Batchvarov V, Synetos A, Hnatkova K, Gatzoulis K, et al. Prognostic significance of inverse spatial QRS-T angle circadian pattern in myocardialinfarction survivors. J Electrocardiol 2009; 42: 79-84.
  • 6. Shirota K, Ogino K, Hoshio A, Kasahara T, Kotake H, Endo S, et al. Changes of QRS axis in transient myocardial ischaemia induced by percutaneous transluminal coronary angioplasty. Eur Heart J 1994; 15: 1391-5.
  • 7. Goldenberg I, Moss AJ, Zareba W. QT interval: how to measure it and what is "normal". J Cardiovasc Electrophysiol 2006; 17: 333-6.
  • 8. Pijls NH, De Bruyne B, Peels K, Van Der Voort PH, Bonnier HJ, Bartunek J Koolen JJ, et al. Measurement of fractional flow reserve to assess the functional severity of coronary artery stenoses. N Engl J Med 1996; 334: 1703-8.
  • 9. De Bruyne B, Fearon WF, Pijls NH, Barbato E, Tonino P, Piroth Z, et al. Fractional flow reserve guided PCI for stable coronary artery disease. N Engl J Med 2014; 371: 1208-17.
  • 10. Scherptong RW, Henkens IR, Man SC, Le Cessie S, Vliegen HW, Draisma HH, et al. Normal limits of the spatial QRST angle and ventricular gradient in 12 lead electrocardiograms of young adults: dependence on sex and heart rate. J Electrocardiol 2008; 41: 648-55.
  • 11. Birnbaum Y, Sclarovsky S. The grades of ischemia on the presenting electrocardiogram of patients with ST elevation acute myocardial infarction. J Electrocardiol 2001; 34 Suppl: 17-26.
  • 12. Gardner PI, Ursell PC, Fenoglio JJ Jr, Wit AL. Electrophysiologic and anatomic basis for fractionated electrograms recorded from healed myocardial infarcts. Circulation 1985; 72: 596–611.
  • 13. Colluoglu T, Tanriverdi Z, Unal B, Ozcan EE, Dursun H, Kaya D. The role of baseline and post-procedural frontal plane QRS-T angles for cardiac risk assessment in patients with acute STEMI. Ann Noninvasive Electrocardiol 2018; 23: e12558.
  • 14. Aro AL, Huikuri HV, Tikkanen JT, Junttila MJ, Rissanen HA, Reunanen A, et al. QRS-T angle as a predictor of sudden cardiac death in a middle-aged general population. Europace 2012; 14: 872–6.
  • 15. Gotsman I, Keren A, Hellman Y, Banker J, Lotan C, Zwas DR. Usefulness of electrocardiographic frontal QRS-T angle to predict increased morbidity and mortality in patients with chronic heart failure. Am J Cardiol 2013; 111: 1452-9.
  • 16. Lown MT, Munyombwe T, Harrison W, West RM, Hall CA, Morrell C, et al.; Evaluation of Methods and Management of Acute Coronary Events (EMMACE) Investigators. Association of frontal QRS-T angle-age risk score on admission electrocardiogram with mortality in patients admitted with an acute coronary syndrome. Am J Cardiol 2012; 109: 307-13.
  • 17. Zhang ZM, Prineas RJ, Case D, Soliman EZ, Rautaharju PM; ARIC Research Group. 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: 844-9.
  • 18. de Torbal A, Kors JA, van Herpen G, Meij S, Nelwan S, Simoons ML, et al. The electrical T-axis and the spatial QRS-T angle are independent predictors of long-term mortality in patients admitted with acute ischemic chest pain. Cardiology 2004; 101: 199–207.
  • 19. Tanriverdi Z, Besli F, Gungoren F, Altiparmak IH, Yesilay AB, Erkus ME, et al. Frontal QRS-T angle as a marker of left ventricular hypertrophy in patients with essential hypertension. DEU Tip Fakultesi Dergisi 2018; 32: 77-87.
  • 20. Zhang Y, Post WS, Blasco-Colmenares E, Dalal D, Tomaselli GF, Guallar E. Electrocardiographic QT interval and mortality: a metaanalysis. Epidemiology 2011; 22: 660-70.
  • 21. Beinart R, Zhang Y, Lima JA, Bluemke DA, Soliman EZ, Heckbert SR, et al. The QT interval is associated with incident cardiovascular events: the MESA study. J Am Coll Cardiol 2014; 64: 2111-9.
APA KARAMAN S, KALKAN A, TÜRKYILMAZ A, Doğan A, avcı y, UZUN F, erturk m (2019). Frontal QRS-T angle is related with hemodynamic significance of coronary artery stenosis in patients with single vessel disease. , 194 - 201. 10.14744/AnatolJCardiol.2019.99692
Chicago KARAMAN Serkan,KALKAN Ali Kemal,TÜRKYILMAZ Ayşe Beril,Doğan Arda Can,avcı yalçın,UZUN FATİH,erturk mehmet Frontal QRS-T angle is related with hemodynamic significance of coronary artery stenosis in patients with single vessel disease. (2019): 194 - 201. 10.14744/AnatolJCardiol.2019.99692
MLA KARAMAN Serkan,KALKAN Ali Kemal,TÜRKYILMAZ Ayşe Beril,Doğan Arda Can,avcı yalçın,UZUN FATİH,erturk mehmet Frontal QRS-T angle is related with hemodynamic significance of coronary artery stenosis in patients with single vessel disease. , 2019, ss.194 - 201. 10.14744/AnatolJCardiol.2019.99692
AMA KARAMAN S,KALKAN A,TÜRKYILMAZ A,Doğan A,avcı y,UZUN F,erturk m Frontal QRS-T angle is related with hemodynamic significance of coronary artery stenosis in patients with single vessel disease. . 2019; 194 - 201. 10.14744/AnatolJCardiol.2019.99692
Vancouver KARAMAN S,KALKAN A,TÜRKYILMAZ A,Doğan A,avcı y,UZUN F,erturk m Frontal QRS-T angle is related with hemodynamic significance of coronary artery stenosis in patients with single vessel disease. . 2019; 194 - 201. 10.14744/AnatolJCardiol.2019.99692
IEEE KARAMAN S,KALKAN A,TÜRKYILMAZ A,Doğan A,avcı y,UZUN F,erturk m "Frontal QRS-T angle is related with hemodynamic significance of coronary artery stenosis in patients with single vessel disease." , ss.194 - 201, 2019. 10.14744/AnatolJCardiol.2019.99692
ISNAD KARAMAN, Serkan vd. "Frontal QRS-T angle is related with hemodynamic significance of coronary artery stenosis in patients with single vessel disease". (2019), 194-201. https://doi.org/10.14744/AnatolJCardiol.2019.99692
APA KARAMAN S, KALKAN A, TÜRKYILMAZ A, Doğan A, avcı y, UZUN F, erturk m (2019). Frontal QRS-T angle is related with hemodynamic significance of coronary artery stenosis in patients with single vessel disease. The Anatolian Journal of Cardiology, 22(4), 194 - 201. 10.14744/AnatolJCardiol.2019.99692
Chicago KARAMAN Serkan,KALKAN Ali Kemal,TÜRKYILMAZ Ayşe Beril,Doğan Arda Can,avcı yalçın,UZUN FATİH,erturk mehmet Frontal QRS-T angle is related with hemodynamic significance of coronary artery stenosis in patients with single vessel disease. The Anatolian Journal of Cardiology 22, no.4 (2019): 194 - 201. 10.14744/AnatolJCardiol.2019.99692
MLA KARAMAN Serkan,KALKAN Ali Kemal,TÜRKYILMAZ Ayşe Beril,Doğan Arda Can,avcı yalçın,UZUN FATİH,erturk mehmet Frontal QRS-T angle is related with hemodynamic significance of coronary artery stenosis in patients with single vessel disease. The Anatolian Journal of Cardiology, vol.22, no.4, 2019, ss.194 - 201. 10.14744/AnatolJCardiol.2019.99692
AMA KARAMAN S,KALKAN A,TÜRKYILMAZ A,Doğan A,avcı y,UZUN F,erturk m Frontal QRS-T angle is related with hemodynamic significance of coronary artery stenosis in patients with single vessel disease. The Anatolian Journal of Cardiology. 2019; 22(4): 194 - 201. 10.14744/AnatolJCardiol.2019.99692
Vancouver KARAMAN S,KALKAN A,TÜRKYILMAZ A,Doğan A,avcı y,UZUN F,erturk m Frontal QRS-T angle is related with hemodynamic significance of coronary artery stenosis in patients with single vessel disease. The Anatolian Journal of Cardiology. 2019; 22(4): 194 - 201. 10.14744/AnatolJCardiol.2019.99692
IEEE KARAMAN S,KALKAN A,TÜRKYILMAZ A,Doğan A,avcı y,UZUN F,erturk m "Frontal QRS-T angle is related with hemodynamic significance of coronary artery stenosis in patients with single vessel disease." The Anatolian Journal of Cardiology, 22, ss.194 - 201, 2019. 10.14744/AnatolJCardiol.2019.99692
ISNAD KARAMAN, Serkan vd. "Frontal QRS-T angle is related with hemodynamic significance of coronary artery stenosis in patients with single vessel disease". The Anatolian Journal of Cardiology 22/4 (2019), 194-201. https://doi.org/10.14744/AnatolJCardiol.2019.99692