Stress-induced QTc-interval shortening as an ancillary marker of ischemia in patients with complete left bundle branch block

Filippo Scalise, Mauro Bertella, Mariella Manfredi, Carla Auguadro, Michele Nanna, Emilio Vanoli, Alberto U. Ferrari, Giuseppe Specchia

Research output: Contribution to journalArticle

Abstract

BACKGROUND: In patients with left bundle branch block (LBBB), ischemia-induced repolarization changes associated with QTc-interval shortening may be recorded during coronary angioplasty.We aimed to assess whether these repolarization changes may be predictive of severe coronary artery disease in patients with LBBB. METHODS: Fifty noninfarcted LBBB patients underwent dipyridamole stress test and coronary angiography for chest pain. To localize the site of ischemia, we considered four groups of conventional ECG leads (V1-V2-V3; V4-V5-V6; aVL-I; III-aVF-II), exploring the anteroseptal, lateral, high-lateral, and inferior left ventricular walls. ST-T changes and QTc intervals were estimated at rest and peak stress, lead by lead, in each group of leads and the fractional percentage difference between rest-stress QTc intervals (ΔQTc) was calculated. A ΔQTc greater than -10% was used to define significant QTc-interval shortening. Coronary stenosis of more than 70% and more than 90% were considered 'significant' and 'severe'. RESULTS: According to dipyridamole stress test response, two groups were identified: group I (35 patients) with dipyridamole-induced ischemia and group II (15 patients) without dipyridamole-induced ischemia. The wall motion score index at peak stress (compared with resting wall motion score index) was significantly higher in group I (1.98 ± 0.13 vs. 1.28 ± 0.08, P <0.0001) than in group II (1.36 ± 0.18 vs. 1.25 ± 0.08, P = 0.296). The patients of group I showed a significant QTc-interval shortening (ΔQTc = -16.9 ± 3.9%), whereas this did not happen in patients of group II (ΔQTc = +8.8 ± 2.4%, P <0.0001). The patients of group I also had a more severe stenosis in the vessel related to the stress-induced dyssynergic area (I = 90.5 ± 9.5 vs. II = 34.3 ± 31.1%; P <0.0001). CONCLUSION: In patients with LBBB, stress-induced pseudonormalization pattern, associated with QTc-interval shortening, allows the identification of cardiac areas supplied by severely stenosed coronary arteries.

Original languageEnglish
Pages (from-to)376-382
Number of pages7
JournalJournal of Cardiovascular Medicine
Volume10
Issue number5
DOIs
Publication statusPublished - May 2009

Fingerprint

Bundle-Branch Block
Ischemia
Dipyridamole
Exercise Test
Coronary Stenosis
Coronary Angiography
Chest Pain
Angioplasty
Coronary Artery Disease
Coronary Vessels
Electrocardiography
Pathologic Constriction

Keywords

  • Dipyridamole stress test
  • Left bundle branch block
  • Myocardial ischemia
  • QTc interval

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Stress-induced QTc-interval shortening as an ancillary marker of ischemia in patients with complete left bundle branch block. / Scalise, Filippo; Bertella, Mauro; Manfredi, Mariella; Auguadro, Carla; Nanna, Michele; Vanoli, Emilio; Ferrari, Alberto U.; Specchia, Giuseppe.

In: Journal of Cardiovascular Medicine, Vol. 10, No. 5, 05.2009, p. 376-382.

Research output: Contribution to journalArticle

Scalise, Filippo ; Bertella, Mauro ; Manfredi, Mariella ; Auguadro, Carla ; Nanna, Michele ; Vanoli, Emilio ; Ferrari, Alberto U. ; Specchia, Giuseppe. / Stress-induced QTc-interval shortening as an ancillary marker of ischemia in patients with complete left bundle branch block. In: Journal of Cardiovascular Medicine. 2009 ; Vol. 10, No. 5. pp. 376-382.
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abstract = "BACKGROUND: In patients with left bundle branch block (LBBB), ischemia-induced repolarization changes associated with QTc-interval shortening may be recorded during coronary angioplasty.We aimed to assess whether these repolarization changes may be predictive of severe coronary artery disease in patients with LBBB. METHODS: Fifty noninfarcted LBBB patients underwent dipyridamole stress test and coronary angiography for chest pain. To localize the site of ischemia, we considered four groups of conventional ECG leads (V1-V2-V3; V4-V5-V6; aVL-I; III-aVF-II), exploring the anteroseptal, lateral, high-lateral, and inferior left ventricular walls. ST-T changes and QTc intervals were estimated at rest and peak stress, lead by lead, in each group of leads and the fractional percentage difference between rest-stress QTc intervals (ΔQTc) was calculated. A ΔQTc greater than -10{\%} was used to define significant QTc-interval shortening. Coronary stenosis of more than 70{\%} and more than 90{\%} were considered 'significant' and 'severe'. RESULTS: According to dipyridamole stress test response, two groups were identified: group I (35 patients) with dipyridamole-induced ischemia and group II (15 patients) without dipyridamole-induced ischemia. The wall motion score index at peak stress (compared with resting wall motion score index) was significantly higher in group I (1.98 ± 0.13 vs. 1.28 ± 0.08, P <0.0001) than in group II (1.36 ± 0.18 vs. 1.25 ± 0.08, P = 0.296). The patients of group I showed a significant QTc-interval shortening (ΔQTc = -16.9 ± 3.9{\%}), whereas this did not happen in patients of group II (ΔQTc = +8.8 ± 2.4{\%}, P <0.0001). The patients of group I also had a more severe stenosis in the vessel related to the stress-induced dyssynergic area (I = 90.5 ± 9.5 vs. II = 34.3 ± 31.1{\%}; P <0.0001). CONCLUSION: In patients with LBBB, stress-induced pseudonormalization pattern, associated with QTc-interval shortening, allows the identification of cardiac areas supplied by severely stenosed coronary arteries.",
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T1 - Stress-induced QTc-interval shortening as an ancillary marker of ischemia in patients with complete left bundle branch block

AU - Scalise, Filippo

AU - Bertella, Mauro

AU - Manfredi, Mariella

AU - Auguadro, Carla

AU - Nanna, Michele

AU - Vanoli, Emilio

AU - Ferrari, Alberto U.

AU - Specchia, Giuseppe

PY - 2009/5

Y1 - 2009/5

N2 - BACKGROUND: In patients with left bundle branch block (LBBB), ischemia-induced repolarization changes associated with QTc-interval shortening may be recorded during coronary angioplasty.We aimed to assess whether these repolarization changes may be predictive of severe coronary artery disease in patients with LBBB. METHODS: Fifty noninfarcted LBBB patients underwent dipyridamole stress test and coronary angiography for chest pain. To localize the site of ischemia, we considered four groups of conventional ECG leads (V1-V2-V3; V4-V5-V6; aVL-I; III-aVF-II), exploring the anteroseptal, lateral, high-lateral, and inferior left ventricular walls. ST-T changes and QTc intervals were estimated at rest and peak stress, lead by lead, in each group of leads and the fractional percentage difference between rest-stress QTc intervals (ΔQTc) was calculated. A ΔQTc greater than -10% was used to define significant QTc-interval shortening. Coronary stenosis of more than 70% and more than 90% were considered 'significant' and 'severe'. RESULTS: According to dipyridamole stress test response, two groups were identified: group I (35 patients) with dipyridamole-induced ischemia and group II (15 patients) without dipyridamole-induced ischemia. The wall motion score index at peak stress (compared with resting wall motion score index) was significantly higher in group I (1.98 ± 0.13 vs. 1.28 ± 0.08, P <0.0001) than in group II (1.36 ± 0.18 vs. 1.25 ± 0.08, P = 0.296). The patients of group I showed a significant QTc-interval shortening (ΔQTc = -16.9 ± 3.9%), whereas this did not happen in patients of group II (ΔQTc = +8.8 ± 2.4%, P <0.0001). The patients of group I also had a more severe stenosis in the vessel related to the stress-induced dyssynergic area (I = 90.5 ± 9.5 vs. II = 34.3 ± 31.1%; P <0.0001). CONCLUSION: In patients with LBBB, stress-induced pseudonormalization pattern, associated with QTc-interval shortening, allows the identification of cardiac areas supplied by severely stenosed coronary arteries.

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KW - Left bundle branch block

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