Association between electrocardiographic parameters and collateral circulation in patients with chronic total occlusion
Association between electrocardiographic parameters and collateral circulation in patients with chronic total occlusion
Aim: In patients with chronic total occlusion (CTO), negative cardiovascular outcomes (angina, more frequent ventricular arrhythmias, higher mortality) and reduced survival have been demonstrated. The association between several electrocardiogram (ECG) markers, revealing individuals at high risk for ventricular arrhythmia, and collateral has been investigated in different studies in coronaryartery disease patients. In this study, we aimed to investigate the association between the electrocardiographic parameters between good coronary collateral group and poor coronary collateral group in CTO patients with PCI.Material and Methods: Patients retrospectively implemented CTO PCI to those with symptomatic symptoms of myocardial ischemia or with the exact sign of ischemia in the CTO area. The patients were divided into 2 groups according to the Rentrop class: group 1 (Rentrop 0 and 1) and group 2 (Rentrop 2 and 3). Baseline characteristics, laboratory and ECGs, procedural data, and outcome data were retrospectively collected.Results: In this study included 59 CTO patients undergoing PCI. Mean age was 61.0±10.3 years and 43 (72.9%) of patients were male, and PCI success was 69.4%. While 22 (37.2%) of the patients were poor collateral group 1 (Rentrop 0 and 1), the remaining 37 (62.3%) of them were good collateral group 2 (Rentrop 2 and 3). There was a significant difference, in poor and good collateral groups, QT dispersion (77.2±27.9 vs 66.5±22.5, p: 0.041, respectively), QTc dispersion (82.1±26.9 vs 70.4±23.9, p: 0.034, respectively), and the presence of fQRS (63.6% vs 43.2, p: 0.027, respectively). But there was no statistically difference in P wave dispersion (48.0±9.5 vs 47.2±11.3, p: 0.796). Correlation analysis reported the association between Rentrop classification and Syntax score (r: -0.397, p: 0.002), LDL-C (r: -0.198, p: 0.025), QT dispersion (r: -0.156, p: 0.045), QTc dispersion (r: -0.176, p: 0.037), and the presence of fQRS (r: 0.234, p: 0.021) were statistically significant.Conclusion: We suggest that some ECG parameters are an important, easy, simple, and cost effective tool and can be beneficial in predicting the poor or good collateral in patients with CTO
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- 1. Sianos G, Werner GS, Galassi AR, et al. EuroCTO Club. Recanalisation of chronic total coronary occlusions: 2012 consensus document from the EuroCTO club. EuroIntervention 2012;8:139-45.
- 2. Hoebers LP, Claessen BE, Dangas GD, et al. Contemporary overview and clinical perspectives of chronic total occlusions. Nat Rev Cardiol 2014;11:458- 69.
- 3. Pancholy SB, Boruah P, Ahmed I, et al. Metaanalysis of effect on mortality of percutaneous recanalization of coronary chronic total occlusions using a stent-based strategy. Am J Cardiol 2013;111:521-5.
- 4. Pijls NH, Bech GJ, el Gamal MI, et al. Quantification of recruitable coronary collateral blood flow in conscious humans and its potential to predict future ischemic events. J Am Coll Cardiol 1995;25:1522-8.
- 5. van Dongen IM, Elias J, VMF Meijborg, et al. Electrocardiographic changes after successful recanalization of a chronic total coronary occlusion. A systematic review and meta-analysis. Cardiovasc Revasc Med. 2018;19:221-8.
- 6. Gupta P, Patel C, Patel H, et al. T(p-e)/QT ratio as an index of arrhythmogenesis. J Electrocardiol 2008;41:567-74.
- 7. Goodhart DM, Hubacek J, Anderson TJ, et al. TOSCA investigators. Effect of percutaneous coronary intervention of nonacute total coronary artery occlusions on QT dispersion. Am Heart J 2006;151:529.
- 8. Cetin M, Zencir C, Cakici M, et al. Effect of a successful percutaneous coronary intervention for chronic total occlusion on parameters of ventricular repolarization. Coron Artery Dis 2014;25:705-12.
- 9. Erdogan E, Akkaya M, Bacaksiz A, et al. Short-term effect of percutaneous recanalization of chronic total occlusions on QT dispersion and heart rate variability parameters. Med Sci Monit 2013;19:696-702.
- 10. Kadı H, Ceyhan K, Koç F, et al. Relation between fragmented QRS and collateral circulation in patients with chronic total occlusion without prior myocardial infarction. Anadolu Kardiyol Derg 2011;11:300-4.
- 11. Rentrop KP, Cohen M, Blanke H, et al. Changes in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects. J Am Coll Cardiol 1985;5:587-92.
- 12. Waggoner AD, Adyanthaya AV, Quinones MA, et al. Left atrial enlargement. Echocardiographic assessment of electrocardiographic criteria. Circulation 1976;54:553.
- 13. Nombela-Franco L, Iannaccone M, Anguera I, et al. Impact of chronic total coronary occlusion on recurrence of ventricular arrhythmias in ischemic secondary prevention implantable cardioverterdefibrillator recipients (vacto secondary study): insights from coronary angiogram and electrogram analysis. JACC Cardiovasc Interv 2017;10:879-88.
- 14. Galassi AR, Tomasello SD, Reifart N, et al. In-hospital outcomes of percutaneous coronary intervention in patients with chronic total occlusion: insights from the ERCTO (European Registry of Chronic Total Occlusion) registry. EuroIntervention 2011;7:472-9.
- 15. Ladwiniec A, Allgar V, Thackray S, et al. Medical therapy, percutaneous coronary intervention and prognosis in patients with chronic total occlusions. Heart 2015;101:1907-14.
- 16. Guo L, Lv HC, Zhong L, et al. Gender differences in long-term outcomes of medical therapy and successful percutaneous coronary intervention for coronary chronic total occlusions. J Interv Cardiol 2019;10:2017958.
- 17. Godino C, Bassanelli G, Economou FI, et al. Predictors of cardiac death in patients with coronary chronic total occlusion not revascularized by PCI. Int J Cardiol 2013;168:1402-09.
- 18. Seiler C, Stoller M, Pitt B, et al. The human coronary collateral circulation: Development and clinical importance. Eur Heart J. 2013;34:2674-82.
- 19. Meier P, Hemingway H, Lansky AJ, et al. The impact of the coronary collateral circulation on mortality: A meta-analysis. Eur Heart J 2012;33:614-21.
- 20. Choi JH, Chang SA, Choi JO, et al. Frequency of myocardial infarction and its relationship to angiographic collateral flow in territories supplied by chronically occluded coronary arteries. Circulation 2013;127:703-09.
- 21. Okin PM, Devereux RB, Howard BV et al. Assessment of QT interval and QT dispersion for prediction of all-cause and cardiovascular mortality in American Indians. The Strong Heart Study. Circulation 2000;101:61-6.
- 22. Tasolar H, Ballı M, Cetin M, et al. Effects of the coronary collateral circulation on the Tp-e interval and Tp-e/QT ratio in patients with stable coronary artery disease. Ann Noninvasive Electrocardiol 2015;20:53-61.
- 23. Yilmaz R, Demirbag R. P-wave dispersion in patients with stable coronary artery disease and its relationship with severity of the disease. J Electrocardiol 2005; 38:279-84.
- 24. Akin F, Firatli I, Katkat F, et al. P-wave dispersion and its relationship with the severity of the disease in patients with stable coronary artery disease. North Clin Istanb 2014;1:65-70.