ANOCA patients with and without coronary vasomotor dysfunction present with limited electrocardiographic remodeling

Area of Science:

• Cardiology
• Electrophysiology
• Diagnostic Imaging

Background:

• Coronary vasomotor dysfunction (CVDys), encompassing coronary vasospasm (CVS) and/or coronary microvascular dysfunction (CMD), is common in angina with non-obstructive coronary artery disease (ANOCA).
• Invasive coronary function testing (CFT) is increasingly utilized for CVDys diagnosis and pathophysiological research.
• Understanding the electrophysiological characteristics of ANOCA patients with CVDys is crucial for improved diagnostic strategies.

Purpose of the Study:

• To investigate the electrophysiological characteristics of ANOCA patients diagnosed with CVDys.
• To compare electrocardiogram (ECG) findings between patients with and without CVDys.
• To identify potential ECG markers associated with CVDys in ANOCA patients.

Main Methods:

• Retrospective analysis of pre-procedural 12-lead ECGs from the NL-CFT registry.
• Inclusion of ANOCA patients categorized into: CVS (n=35), CMD (n=24), CVS/CMD (n=26), and no CVDys (CFT-, n=23).
• Comparison of heart axis, conduction times, and QTc intervals (QTcB, QTcF) between patient groups.

Main Results:

• Heart axis, heart rate, PQ interval, and QRS duration were similar across all groups.
• A statistically significant, albeit small, prolongation of the corrected QT interval (QTc) was observed in patients with CMD and CVS/CMD compared to those without CVDys (p<0.05).
• Patients with CVS also showed a trend towards prolonged QTc intervals, though not statistically significant (p>0.05).

Conclusions:

• Pre-procedural ECGs in ANOCA patients with CVDys show a slightly prolonged QTc interval compared to those without CVDys.
• This finding suggests limited cardiac remodeling in patients with CVDys.
• The prolonged QTc interval may serve as a potential, non-invasive indicator in the diagnostic workup of CVDys.