Coronary Artery Ectasia Predicts Future Cardiac Events in Patients With Acute Myocardial Infarction

Doi, Takahito; Kataoka, Yasufumi; Noguchi, Teruo; Shibata, Tatsuhiro; Nakashima, Takahiro; Kawakami, Shoji; Nakao, Kazuhiro; Fujino, Masashi; Nagai, Toshiyuki; Kanaya, Tomoaki; Terada, Yoshio; Asaumi, Yasuhide; Tsuda, Etsuko; Nakai, Michikazu; Nishimura, Kunihiro; Anzai, Toshihisa; Kusano, Kengo; Shimokawa, Hiroaki; Goto, Yoichi; Yasuda, Satoshi

doi:10.1161/atvbaha.117.309683

Cited by 120 publications

(107 citation statements)

References 23 publications

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“…Long-term cardiovascular outcomes of patients with CAE suffering from acute coronary syndromes were always a question needing an answer. Doi et al in their study showed a significant prognostic effect of CAE in these patients with improved outcomes in cases treated with therapeutic oral anticoagulation [10].…”

Section: Introductionmentioning

confidence: 89%

Role of QRS fragmentation in 12-lead surface ECG in prediction of isolated epicardial coronary artery ectasia and its anatomical distribution in patients without acute coronary syndromes

Kamal

Hashem

2020

Egypt Heart J

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Background: Coronary artery ectasia (CAE) is a form of abnormal coronary artery lumen dilatation associated with epicardial flow disturbances and microvascular dysfunction. QRS complex fragmentation (fQRS) in surface ECG is caused by abnormal depolarization due to myocardial ischemia and scarring. It has been proved in different studies to be positively correlated with adverse cardiac events. This study aimed to assess the role of fQRS as a noninvasive predictor of CAE and its anatomical distribution. A total of 100 patients referred for elective coronary angiography were included and divided into 2 groups: 50 patients with isolated CAE (group A) and 50 patients with angiographically normal coronaries (group B, control group). Both groups were compared regarding clinical, echocardiographic, and ECG characteristics. Results: Univariate analysis showed a significant correlation between male sex, smoking, diabetes mellitus, increased systolic blood pressure, fQRS, echocardiographic evidence of diastolic dysfunction, and CAE (P values of 0.005, 0.002, 0.016, 0.027, 0.0001, and 0.04, respectively). Multivariate regression analysis showed that fQRS is the most important independent predictor for the presence of CAE (P < 0.00001) with sensitivity 94%, specificity 88%, PPV 88.7%, and NPV 93.6%. We also found a significant correlation between fQRS distribution in surface ECG and anatomical distribution of CAE [increased territories with multivessel affection (P = 0.00001), anterior leads with LAD affection (P = 0.00001), lateral and inferior leads with LCX affection (P = 0.003 and 0.04, respectively), inferior leads with RCA affection (P = 0.00001)]. Conclusion: fQRS in surface ECG can potentially be used as an effective non-invasive method to predict isolated CAE and its anatomical distribution. Publisher's NoteSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Section: Introductionmentioning

confidence: 89%

Role of QRS fragmentation in 12-lead surface ECG in prediction of isolated epicardial coronary artery ectasia and its anatomical distribution in patients without acute coronary syndromes

Kamal

Hashem

2020

Egypt Heart J

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“…The clinical and prognostic significance of CAE is not clearly understood. CAE may be a cause of coronary rupture, spasm, dissection, thrombosis, myocardial ischemia and even sudden cardiac death eventually [3,4]. As a result this condition may not be accepted completely benign as it is associated with adverse coronary events [5].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of index of cardio-electrophysiological balance and Tp-e/QT ratio in patients with coronary artery ectasia

Alsancak¹,

Gürbüz²,

Saklı³

et al. 2019

Journal of Surgery and Medicine

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Index of cardiac electrophysiological balance (iCEB), calculated as QT interval divided by QRS duration, has been described as a novel risk marker for predicting malignant ventricular arrhythmia. Increased levels of iCEB predict to torsades de pointes (TdP) and decreased levels of iCEB predict to non-torsades de pointes mediated ventricular tachycardia or ventricular fibrillation. The aim of this study is to evaluate arrhythmogenic risk by using iCEB in patients with coronary ectasia (CAE). Methods: Our study, designed as case-control, included 130 patients who were admitted to our outpatient clinic. 75 patients with isolated CAE (study group) and 55 healthy subjects (control group) were included in the study. Both groups underwent a standard 12-lead surface electrocardiogram and Tp-Te interval, QT interval, QRS interval, Tp-Te/QT ratio and QT/QRS ratio (iCEB) of patients were recorded and compared between groups. Results: Tp-e intervals and Tp-e/QT ratio is significantly higher in study group (p=0.001). And, iCEB was found as tend to be numerically higher in study group, but we could not match a statistically difference between groups (p=0.118). Tp-e and Tpe/QT ratio were higher in patients with two or three vessels CAE than one vessel (p value; for Tp-e p=0.024 and Tpe/QT ratio p=0.028). Although iCEB was found as higher with affected number of coronary artery, there was no statistically difference between groups. Conclusion: Our results demonstrate that CAE patients have significantly higher values of Tp-Te and Tp-Te/QT than controls. We need further studies to show increased arrhythmogenesis risk using iCEB for individuals with CAE.

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“…У пациентов с ишемической болезнью сердца (ИБС) наличие сопутствующих АКА является независимым предиктором смертельных исходов [6,[15][16][17]. Одна из причин неблагоприятного влияния на прогноз связана с высокой вероятностью тромбирования аневризм и развитием острого коронарного синдрома (ОКС), вызванного окклюзией крупной ветви артерии либо эмболией дистального сосудистого русла фрагментами тромботических масс, вымываемых из аневризматического мешка.…”

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“…Так, известно, что АКА чаще обнаруживаются у мужчин, при этом, как и в обсуждаемом клиническом примере, поражается преимущественно ПКА [1][2][3][4][5][6]. Считаем уместным еще раз напомнить, что тромбоз АКА служит частой причиной ОКС [6,[15][16][17]. В этой связи весьма логично предположить взаимосвязь аневризмы ПКА и перенесенного инфаркта миокарда нижней локализации у представляемого больного.…”

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“…Полагают [4,22,23], что препаратами выбора при данной патологии могут быть антикоагулянты, опыт использования которых, к сожалению, ограничивается относительно небольшими наблюдательными исследованиями и регистрами. Одно из наиболее показательных исследований [17] включало 1698 больных с инфарктом миокарда, подвергнутых ангиографии с последующим инвазивным лечением. АКА были обнаружены в 51 (3%) случае, и их наличие совершенно логично ассоциировалось с более чем трехкратным увеличением риска всех ишемических исходов, включая сосудистую смерть и нефатальный инфаркт миокарда, большинство случаев которого было связано с тромбозом аневризмы.…”

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Клинический Случай Гигантской Аневризмы Правой Коронарной Артерии

Комаров¹,

Fedotkina²,

Меркулов³

et al. 2019

Kardiologicheskii Vestnik

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Представлен клинический разбор больного с ишемической болезнью сердца, многососудистым поражением коронарного русла и гигантской аневризмой коронарной артерии. Рассмотрены возможные подходы к выбору медикаментозного и инвазивного лечения.There was presented a clinical discussion of the patient with coronary heart disease, multivessel coronary artery disease and huge aneurysm of coronary artery. Potential approaches to selecting conservative and invasive treatment were discussed.

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Coronary Artery Ectasia Predicts Future Cardiac Events in Patients With Acute Myocardial Infarction

Abstract: The presence of CAE predicted future cardiac events in patients with acute MI. Our findings suggest that acute MI patients with CAE are a high-risk subset who might benefit from a pharmacological approach to controlling the coagulation cascade.

Cited by 120 publications

References 23 publications

Role of QRS fragmentation in 12-lead surface ECG in prediction of isolated epicardial coronary artery ectasia and its anatomical distribution in patients without acute coronary syndromes

Role of QRS fragmentation in 12-lead surface ECG in prediction of isolated epicardial coronary artery ectasia and its anatomical distribution in patients without acute coronary syndromes

Evaluation of index of cardio-electrophysiological balance and Tp-e/QT ratio in patients with coronary artery ectasia

Клинический Случай Гигантской Аневризмы Правой Коронарной Артерии

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