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The Diagnostic Value of ECG Characteristics for Vasospastic and Microvascular Angina: A Systematic Review
Diantha J M Schipaanboord1, Janneke Woudstra2, Yolande Appelman2
1Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Insights
Electrocardiography (ECG) may offer noninvasive diagnosis for vasospastic angina (VSA) and microvascular angina (MVA). Repolarization abnormalities and QTc interval show predictive value, aiding risk stratification in angina without obstructive coronary artery disease (ANOCA).
Area of Science:
- Cardiology
- Diagnostic Imaging
- Medical Diagnostics
Background:
- Coronary vascular dysfunction, including vasospastic angina (VSA) and microvascular angina (MVA), is more prevalent in women with angina without obstructive coronary artery disease (ANOCA).
- Invasive coronary function testing, the gold standard for diagnosis, imposes a significant patient burden.
- This study explores electrocardiography (ECG) as a potential noninvasive diagnostic tool for VSA and MVA.
Approach:
- A systematic literature review of Pubmed and EMBASE databases was conducted to identify studies on ECG characteristics in ANOCA patients with suspected coronary vascular dysfunction.
- Study quality was assessed using QUADAS-2, and data on the diagnostic values of ECG characteristics were extracted.
- Analysis included an assessment of whether studies reported sex-stratified results.
Key Points:
- Thirty publications were included, focusing on VSA (13 studies) and MVA (17 studies), with a majority examining repolarization-related ECG parameters.
- Limited studies reported diagnostic accuracy measures for ECG characteristics.
- Predictive ECG features for VSA included early repolarization, T-wave alternans, and inverted U waves; the QTc interval was predictive for MVA.
Conclusions:
- ECG features are underutilized in diagnostic studies for VSA and MVA.
- Identified ECG markers, primarily related to repolarization abnormalities, demonstrate potential for noninvasive diagnosis and risk stratification.
- Further research is needed to fully establish ECG's role in diagnosing VSA and MVA, particularly with sex-stratified analyses.
Background:
Coronary vascular dysfunction comprises VSA and/or MVA and is more common in women than in men with angina without obstructive coronary artery disease (ANOCA). Invasive coronary function testing is considered the reference test for diagnosis, but its burden on patients is large. We aimed to investigate the potential of electrocardiography (ECG) as noninvasive marker for vasospastic angina (VSA) and microvascular angina (MVA) diagnosis.
Methods:
We systematically screened Pubmed and EMBASE databases for studies reporting on ECG characteristics in ANOCA patients with (a suspicion of) coronary vascular dysfunction. We assessed study quality using QUADAS-2. We extracted data on diagnostic values of different ECG characteristics and analyzed whether the studies were sex-stratified.
Results:
Thirty publications met our criteria, 13 reported on VSA and 17 on MVA. The majority addressed repolarization-related ECG parameters. Only 1 of the 13 VSA papers and 4 of the 17 MVA papers showed diagnostic accuracy measures of the ECG characteristics. The presence of early repolarization, T-wave alternans, and inverted U waves showed of predictive value for VSA diagnosis. The QTc interval was predictive for MVA diagnosis in all six studies reporting on QTc interval. Sex-stratified results were reported in only 5 of the 30 studies and 3 of those observed sex-based differences.
Conclusions:
ECG features are not widely evaluated in diagnostic studies for VSA and MVA. Those features predictive for VSA and MVA diagnosis mostly point to repolarization abnormalities and may contribute to noninvasive risk stratification.
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