Early repolarization and positive T-wave alternans as risk markers for life-threatening arrhythmias in patients with vasospastic angina

Inamura, Yukihiro; Nishizaki, Mitsuhiro; Shimizu, Masato; Fujii, H.; Yamawake, Noriyosi; Sakurada, Harumizu; Hiraoka, Masayasu; Isobe, Mitsuaki

doi:10.1016/j.ijcard.2015.05.147

Cited by 20 publications

(34 citation statements)

References 34 publications

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“…However, in addition to J‐wave augmentation, QRS interval widening and J‐ST–segment elevation were also documented in previously reported cases of ERS, in accordance with electrocardiographic characteristics observed in acute ischemia settings 9, 10, 19. In this study, available ECGs before the onset of VF in 3 patients with CAS also showed specific J‐wave and QRST characteristics, in agreement with previous ERS studies 1, 12.…”

Section: Discussionsupporting

confidence: 92%

“…In this study, available ECGs before the onset of VF in 3 patients with CAS also showed specific J‐wave and QRST characteristics, in agreement with previous ERS studies 1, 12. Inamura et al showed that the J wave was augmented in the leads associated with ischemic areas, caused by acetylcholine‐induced vasospasm 10. This suggests that previously reported cases of ERS may have included those with silent CAS and the J‐wave augmentation may be related to ischemic events.…”

Section: Discussionsupporting

confidence: 90%

“…In addition, inferolateral J wave has been reported in 21% to 36% of patients with CAS 9, 10. Oh et al and Inamura et al independently showed that inferolateral J wave was associated with fatal ventricular arrhythmias in patients with CAS 9, 10. Thus far, the differentiation between patients with CAS and ERS was mainly based on the absence of chest symptoms and normal CAG.…”

Section: Discussionmentioning

confidence: 99%

“…It is known that CAS may induce fatal ventricular arrhythmias without apparent chest symptoms 7, 8. In addition, inferolateral J wave has been associated with an increased risk of fatal ventricular arrhythmias in patients with CAS 9, 10, 11. This indicates that silent CAS (ie, CAS without any symptoms before VF) may have been present in previously reported cases of ERS.…”

mentioning

confidence: 93%

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Significance of Coronary Artery Spasm Diagnosis in Patients With Early Repolarization Syndrome

Kamakura

Wada

Ishibashi

et al. 2018

JAHA

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BackgroundPreviously described patients with early repolarization syndrome (ERS) may have experienced silent coronary artery spasm (CAS) because the diagnosis of CAS was mainly based on symptoms or coronary angiography findings, without performing a spasm provocation test. This study investigated the significance of CAS diagnosis and evaluated the incidence of silent CAS in patients with possible ERS (ie, idiopathic ventricular fibrillation [VF] and inferolateral J wave).Methods and ResultsThe study included 34 patients with idiopathic VF and inferolateral J wave. Thirteen patients (38%) were diagnosed as having CAS on the basis of coronary angiography with spasm provocation test (n=8) and documentation of spontaneous ST elevation (n=5). Of the 13 patients with CAS, 5 (38%) did not experience chest symptoms before and during VF, and were diagnosed as having silent CAS. The remaining 21 patients (62%), with a negative provocation test result and absence of chest symptoms, were considered to have ERS. During the 92 months of follow‐up, patients with CAS receiving appropriate medical treatment with antianginal drugs showed a favorable outcome. In contrast, 4 of 21 patients with ERS (19%) had VF recurrences. The use of monotherapy or combination therapy, consisting of quinidine, cilostazol, and bepridil, in the 4 patients with ERS, was effective in suppressing VF.ConclusionsApproximately 40% of patients with CAS with documented VF and inferolateral J wave did not experience chest symptoms at the first VF, and could have been misdiagnosed as having ERS. The use of the spasm provocation test is considered essential to differentiate patients for optimal medical treatment.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 93%

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Significance of Coronary Artery Spasm Diagnosis in Patients With Early Repolarization Syndrome

Kamakura

Wada

Ishibashi

et al. 2018

JAHA

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“…По данным Inamura Y, et al, риск развития таких аритмий относительно неве-лик и не превышает 10% [12], а одним из способов их профилактики является имплантация кардиовертера-дефибриллятора [13].…”

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Vasospasm as a Cause of Type 2 Myocardial Infarction. Tactics Outside the Guidelines

Лысенко¹,

Ванюков²,

Потешкина³

et al. 2017

Russ J Cardiol

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Согласно третьему универсальному определению инфаркта миокарда (ИМ), имеется несколько раз-личных механизмов развития некроза кардиомиоци-тов [1]. ИМ 1 типа обусловлен атеротромбозом, типы 4 и 5 связаны с проведением различного рода меди-цинских манипуляций (чрескожных коронарных вмешательств и коронарного шунтирования). ИМ 3 типа диагностируют у внезапно умерших пациентов при невозможности получения данных о повышении кардиоспецифических ферментов и при наличии предшествующей картины поражения миокарда [1]. Наиболее широким представляется определение ИМ 2 типа, объединившее различные патогенетические механизмы развития некроза кардиомиоцитов, такие как коронарный вазоспазм, эндотелиальная дис-функция, метаболические нарушения и иные при-чины. Единый механизм, за счет которого все эти состояния приводят к ИМ 2 типа -критическое снижение перфузии [1,2].Какие заболевания наиболее часто приводят к раз-витию ИМ 2 типа? Данный тип ИМ может быть обусловлен целым рядом различных состояний и заболеваний, таких как сепсис и септический шок, тяжелая дыхательная недостаточность, тахи-и бради-аритмии, коронароспазм, поражение аортального клапана, васкулит и коронариит, миокардит, травма сердца, тяжелая почечная недостаточность, анемия и некоторые другие. В результате течения вышеука-занных заболеваний создается гемодинамический дисбаланс между потребностью миокарда в кисло-роде и объемом перфузии [1]. Такой дисбаланс может быть обусловлен механическими причинами, как при вазоспазме, а может носить относительный характер, как, например, при тахиаритмиях, когда потребность Лысенко М. А. -д. м.н., главный врач, профессор кафедры общей терапии фДПО, Ванюков А. е. -зав. отделением рентгенэндоваскулярных методов диагностики и лечения, рентгенэндоваскулярный хирург, Потешкина Н. Г. -д. м.н., профессор, зав. кафедрой общей терапии фДПО, врач-кардиолог, суворов А. Ю.* -к. м.н., ассистент кафедры общей терапии фДПО, врач отде-ления функциональной диагностики, самсонова И. В. -к. м.н., заместитель главного врача по медицинской части, Ковалевская е. А. -зав. 2-м кардиоло-гическим отделением.*Автор, ответственный за переписку (Corresponding author): nnexen@gmail.com ДИ -доверительный интервал, ИМ -инфаркт миокарда, КАГ -коронароан-гиография, ОР -относительный риск, ПНА -передняя нисходящая артерия, ссЗ -сердечно-сосудистые заболевания, фВ -фракция выброса, ХМ-эКГ -холтеровское мониторирование, Чсс -частота сердечных сокраще-ний, эКГ -электрокардиограмма, эхо-КГ -эхокардиография. The review is focused on the recent data on the causes of type 2 myocardial infarction and specifics of its diagnostics and management in patients with vasospastic angina. significance of the problem is based upon the fact that strategies of this sort of patients management are lacking and usually do not fit guidelines. There is absence of agreed princips of long term management of such patients. The selection of strategy (medication therapy, revascularization of the spastic region, prevention of complications and another infarction) is disputable. The case prov...

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Association of early repolarization pattern and ventricular fibrillation in patients with vasospastic angina: A systematic review and meta‐analysis

Wang

Zhao

Zhong

et al. 2022

Clinical Cardiology

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Background An early repolarization (ER) pattern is a risk factor for ventricular fibrillation (VF) in patients with vasospastic angina (VSA) caused by a coronary artery spasm. However, its detailed characteristics and prognostic value for VF remain unclear. Thus, we investigated the relationship between ER and VF in patients with VSA. Hypothesis The ER pattern is associated with VF in patients with VSA. Methods In this systematic review and meta‐analysis, we searched PubMed, Embase, Cochrane Library, and Web of Science databases for eligible studies published between January 2011 and December 2020; 8 studies with 1761 patients were included in the final analysis. Results The ER pattern significantly predicted adverse cardiovascular events (ACEs) and VF (odds ratio [OR] = 5.13, 95% confidence interval [95% CI]: 3.16–8.35, p < .00001 and OR = 5.20, 95% CI: 3.05–8.87, p < .00001). The presence of ER in the inferior leads increased the VF risk (OR = 7.80, 95% CI: 4.04–15.05, p < .00001), regardless of the J‐point morphology or type of ST‐segment elevation in the ER pattern. A horizontal/descending ST‐segment elevation was significantly associated with VF in patients with or without an ER pattern during a coronary spasm (OR = 2.28, 95% CI: 1.07–4.88, p = .03). However, obstructive coronary artery disease was unrelated to the ER pattern (OR = 0.82, 95% CI: 0.27–2.53, p = .73). Conclusions An ER pattern is significantly associated with an increased risk of ACE in patients with VSA. An inferior ER pattern with horizontal/descending ST‐segment elevation confers the highest risk for VF during VSA onset. Nevertheless, the ER pattern is not associated with obstructive coronary artery disease.

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Early repolarization and positive T-wave alternans as risk markers for life-threatening arrhythmias in patients with vasospastic angina

Cited by 20 publications

References 34 publications

Significance of Coronary Artery Spasm Diagnosis in Patients With Early Repolarization Syndrome

Significance of Coronary Artery Spasm Diagnosis in Patients With Early Repolarization Syndrome

Vasospasm as a Cause of Type 2 Myocardial Infarction. Tactics Outside the Guidelines

Association of early repolarization pattern and ventricular fibrillation in patients with vasospastic angina: A systematic review and meta‐analysis

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