Improvement of the frontal QRS-T angle after successful percutaneous coronary revascularization in patients with chronic total occlusion.
Journal
Coronary artery disease
ISSN: 1473-5830
Titre abrégé: Coron Artery Dis
Pays: England
ID NLM: 9011445
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
pubmed:
18
8
2020
medline:
12
10
2021
entrez:
18
8
2020
Statut:
ppublish
Résumé
The QRS-T angle (QRS-Ta) is a novel marker of myocardial repolarization heterogeneity which is related to adverse cardiovascular events. Our aim in this study was to investigate the effect of successful percutaneous coronary intervention (PCI) on frontal QRS-Ta in patients with chronic total occlusion (CTO). A total of 132 patients undergoing PCI for CTO were included in this study. Successful PCI of CTO segment was performed in 84 patients (group 2) while 48 who failed CTO were observed (group 1). Baseline demographic and clinical variables were evaluated and, 12-lead surface ECGs of all subjects were recorded before performing coronary angiography and 1-month and 6-month after the index procedure. QRS-Ta values significantly decreased during follow-up visits compared to baseline values [92.5 (63.25-110.75); 85.0 (59.0-101.0); 80.0 (53.0-99.0), P < 0.001] in group 2 patients. Moreover, there was no significant difference in frontal QRS-Ta measurements in group 1 patients in their clinical 6-month follow-up [87.0 (48.25-103.0); 86.5 (46.0-101.75); 84.0 (49.0-103.75); P = 0.320]. First month frontal QRS-Ta values [92.5 (63.25-110.75); 85.0 (59.0-101.0), P = 0.002] and sixth month frontal QRS-Ta values [92.5 (63.25-110.75); 80.0 (53.0-99.0), P < 0.001] were lower than baseline values while sixth month values [85.0 (59.0-101.0); 80.0 (53.0-99.0), P = 0.002] was lower compared to first month values. Additionally, a decrease in frontal QRS-Ta was observed regardless of target vessel or Rentrop classification. Successful percutaneous revascularization of CTO was effective in ventricular repolarization. Frontal QRS-Ta significantly decreased after successful PCI on CTO patients at a 6-month follow-up.
Sections du résumé
BACKGROUND
The QRS-T angle (QRS-Ta) is a novel marker of myocardial repolarization heterogeneity which is related to adverse cardiovascular events. Our aim in this study was to investigate the effect of successful percutaneous coronary intervention (PCI) on frontal QRS-Ta in patients with chronic total occlusion (CTO).
MATERIALS AND METHODS
A total of 132 patients undergoing PCI for CTO were included in this study. Successful PCI of CTO segment was performed in 84 patients (group 2) while 48 who failed CTO were observed (group 1). Baseline demographic and clinical variables were evaluated and, 12-lead surface ECGs of all subjects were recorded before performing coronary angiography and 1-month and 6-month after the index procedure.
RESULTS
QRS-Ta values significantly decreased during follow-up visits compared to baseline values [92.5 (63.25-110.75); 85.0 (59.0-101.0); 80.0 (53.0-99.0), P < 0.001] in group 2 patients. Moreover, there was no significant difference in frontal QRS-Ta measurements in group 1 patients in their clinical 6-month follow-up [87.0 (48.25-103.0); 86.5 (46.0-101.75); 84.0 (49.0-103.75); P = 0.320]. First month frontal QRS-Ta values [92.5 (63.25-110.75); 85.0 (59.0-101.0), P = 0.002] and sixth month frontal QRS-Ta values [92.5 (63.25-110.75); 80.0 (53.0-99.0), P < 0.001] were lower than baseline values while sixth month values [85.0 (59.0-101.0); 80.0 (53.0-99.0), P = 0.002] was lower compared to first month values. Additionally, a decrease in frontal QRS-Ta was observed regardless of target vessel or Rentrop classification.
CONCLUSION
Successful percutaneous revascularization of CTO was effective in ventricular repolarization. Frontal QRS-Ta significantly decreased after successful PCI on CTO patients at a 6-month follow-up.
Identifiants
pubmed: 32804782
doi: 10.1097/MCA.0000000000000935
pii: 00019501-202012000-00007
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
716-721Références
Hoebers LP, Claessen BE, Dangas GD, Råmunddal T, Mehran R, Henriques JP. Contemporary overview and clinical perspectives of chronic total occlusions. Nat Rev Cardiol. 2014; 11:458–469
Olivari Z, Rubartelli P, Piscione F, Ettori F, Fontanelli A, Salemme L, et al.; TOAST-GISE Investigators. Immediate results and one-year clinical outcome after percutaneous coronary interventions in chronic total occlusions: data from a multicenter, prospective, observational study (TOAST-GISE). J Am Coll Cardiol. 2003; 41:1672–1678
Suero JA, Marso SP, Jones PG, Laster SB, Huber KC, Giorgi LV, et al. Procedural outcomes and long-term survival among patients undergoing percutaneous coronary intervention of a chronic total occlusion in native coronary arteries: a 20-year experience. J Am Coll Cardiol. 2001; 38:409–414
Dzavik V, Carere RG, Mancini GB, Cohen EA, Catellier D, Anderson TE, et al.; Total Occlusion Study of Canada Investigators. Predictors of improvement in left ventricular function after percutaneous revascularization of occluded coronary arteries: a report from the Total Occlusion Study of Canada (TOSCA). Am Heart J. 2001; 142:301–308
Godino C, Bassanelli G, Economou FI, Takagi K, Ancona M, Galaverna S, et al. Predictors of cardiac death in patients with coronary chronic total occlusion not revascularized by PCI. Int J Cardiol. 2013; 168:1402–1409
Oehler A, Feldman T, Henrikson CA, Tereshchenko LG. QRS-T angle: a review. Ann Noninvasive Electrocardiol. 2014; 19:534–542
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 myocardial infarction survivors. J Electrocardiol. 2009; 42:79–84
Shirota K, Ogino K, Hoshio A, Kasahara T, Kotake H, Endo S, Mashiba H. Changes of QRS axis in transient myocardial ischaemia induced by percutaneous transluminal coronary angioplasty. Eur Heart J. 1994; 15:1391–1395
Sianos G, Werner GS, Galassi AR, Papafaklis MI, Escaned J, Hildick-Smith D, et al.; EuroCTO Club. Recanalisation of chronic total coronary occlusions: 2012 consensus document from the EuroCTO club. Eurointervention. 2012; 8:139–145
Rentrop KP, Cohen M, Blanke H, Phillips RA. Changes in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects. J Am Coll Cardiol. 1985; 5:587–592
Joyal D, Afilalo J, Rinfret S. Effectiveness of recanalization of chronic total occlusions: a systematic review and meta-analysis. Am Heart J. 2010; 160:179–187
Nombela-Franco L, Mitroi CD, Fernández-Lozano I, García-Touchard A, Toquero J, Castro-Urda V, et al. Ventricular arrhythmias among implantable cardioverter-defibrillator recipients for primary prevention: impact of chronic total coronary occlusion (VACTO Primary Study). Circ Arrhythm Electrophysiol. 2012; 5:147–154
Kirschbaum SW, Baks T, van den Ent M, Sianos G, Krestin GP, Serruys PW, et al. Evaluation of left ventricular function three years after percutaneous recanalization of chronic total coronary occlusions. Am J Cardiol. 2008; 101:179–185
Shaw LJ, Berman DS, Maron DJ, Mancini GB, Hayes SW, Hartigan PM, et al.; COURAGE Investigators. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation. 2008; 117:1283–1291
Claessen BE, van der Schaaf RJ, Verouden NJ, Stegenga NK, Engstrom AE, Sjauw KD, et al. Evaluation of the effect of a concurrent chronic total occlusion on long-term mortality and left ventricular function in patients after primary percutaneous coronary intervention. JACC Cardiovasc Interv. 2009; 2:1128–1134
Sadanandan S, Buller C, Menon V, Dzavik V, Terrin M, Thompson B, et al. The late open artery hypothesis – a decade later. Am Heart J. 2001; 142:411–421
Kahraman S, Kalkan AK, Turkyilmaz AB, Dogan AC, Avci Y, Uzun F, Erturk M. Frontal QRS-T angle is related with hemodynamic significance of coronary artery stenosis in patients with single vessel disease. Anatol J Cardiol. 2019; 22:194–201
Dogan A, Kahraman S. Frontal QRS-T angle predicts coronary atherosclerotic burden in patients with ST segment elevation myocardial infarction. J Electrocardiol. 2020; 58:155–159
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; 100:844–849
de Torbal A, Kors JA, van Herpen G, Meij S, Nelwan S, Simoons ML, Boersma E. 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
Kahraman S, Yilmaz E, Demir AR, Avci Y, Güler A, Kalkan AK, et al. The prognostic value of frontal QRS-T angle in patients undergoing transcatheter aortic valve implantation. J Electrocardiol. 2019; 55:97–101
Borleffs CJ, Scherptong RW, Man SC, van Welsenes GH, Bax JJ, van Erven L, et al. Predicting ventricular arrhythmias in patients with ischemic heart disease: clinical application of the ECG-derived QRS-T angle. Circ Arrhythm Electrophysiol. 2009; 2:548–554
Cetin M, Zencir C, Cakici M, Yildiz E, Tasolar H, Balli M, et al. Effect of a successful percutaneous coronary intervention for chronic total occlusion on parameters of ventricular repolarization. Coron Artery Dis. 2014; 25:705–712