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

Sinan Cemgil Özbek

doi:10.28982/josam.754698

Authors

Sinan Cemgil Özbek https://orcid.org/0000-0001-9056-8350

DOI:

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

Keywords:

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

Abstract

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.

Downloads

Download data is not yet available.

References

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

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

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

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

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.

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

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

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

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

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

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

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

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

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

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

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

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

Bazett H. An analysis of the time relations of electrocardiograms. Heart 7:353-370. 1920.

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

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

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

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

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

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

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

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

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.

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

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

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

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

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

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

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

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

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

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