Correlation between Tp-Te Interval and Myocardial Blush Grade Value in Anterior ST Elevation Myocardial Infarction Patient

Rio Probo Kaneko; Erika Maharani; Nahar Taufiq

doi:10.22146/aci.40849

Correlation between Tp-Te Interval and Myocardial Blush Grade Value in Anterior ST Elevation Myocardial Infarction Patient

https://doi.org/10.22146/aci.40849

Rio Probo Kaneko^(1*), Erika Maharani⁽²⁾, Nahar Taufiq⁽³⁾

(1) Department of Cardiology and Vascular Medicine Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada – Dr. Sardjito Hospital, Yogyakarta
(2) Department of Cardiology and Vascular Medicine Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada – Dr. Sardjito Hospital, Yogyakarta
(3) Department of Cardiology and Vascular Medicine Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada – Dr. Sardjito Hospital, Yogyakarta
(*) Corresponding Author

Abstract

Background: Clinical manifestations of coronary herat disease (CHD) may be an ST-Elevation Myocardial Infarction (STEMI). In STEMI condition, there is a metabolic disorder and ion exchange disturbance which causes dispersion of transmural repolarization, as well as micro coronary circulation disturbance involving mechanism of microvascular dysfunction. The Tp-Te interval is an electrocardiogram paramener that could be described as the transmural dispersion of repolarization. Assessment of Myocardial Blush Grade (MBG) is a coronary angiography densitometry method that can be used to assess microvascular dysfunction. This study aims to examine the correlation between Tp-Te interval and MBG in anterior STEMI.

Methods: The research desgin is cross sectional. Data were taken consecutive from August to November 2017. The Tp-Te interval assessment was performed on the basis of an electrocardiogram record from the subjects. The MBG value assessment was performed using a Quantitative Blush Evaluator (QuBE) computer program based on coronary angiography. The Tp-Te interval is divided into 2 groups: Tp-Te interval > 94 ms and Tp-Te interval ≤ 94 ms. The MBG values are divided into 3 groups: MBG QuBE 1, MBG QuBE 2 and MBG QuBE 3. The assessment of Tp-Te interval and MBG value was performed by observer in intra-observer which were acknowledged based on Kappa and blindness conformity test results against patient clinical data. Pearson correlation test was used to analyze the correlation between Tp-Te interval and MBG value, while logistic regression test was used for multivariate test.

Results: Of the total 32 study subjects, there were 23 subjects with Tp-Te interval >94 ms and 9 subjects with Tp-Te interval ≤94 ms. There was a negative correlationwith moderate strength between the Tp-Te interval and the MBG value in the anterior STEMI patients (r =-0.501, p =0.004). There was a prevalence ratio of 4.304 between Tp-Te interval >94 milliseconds against MBG QuBE 1 (95%CI: 1.264-14.658, p <0.001). Multivariate tests showed Tp-Te intervals consistently as independent risk factors for MBG values in subjects with anterior STEMI.

Conclusion: There is a negative correlation with moderate strength between the Tp-Te interval and the MBG value in the anterior STEMI patients.

Keywords

Tp-Te Interval; myocardial blush grade; anterior STEMI

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References

Widimsky P., Wijns W., Fajadet J., De Belder M., Knot J., Aaberge L. 2010. Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries. Eur Heart J, 31:943-957.

Naghavi M., Libby P., Falk E., Casscells S.W., Litovsky S., Rumberger J., et al. 2003. From vulnerable plaque to vulnerable patient : a call for new definitions and risk assesment strategies. Circulation, 108: 1664-1672.

June W.R., Sabatine M.S., Lilly L.S. 2011. Patophysiology of heart disease Ischemic Heart Disease. Lippincott Williams and Wilkins

Burton F.L., Cobbe, S.M. 2001. Dispersion of ventricular repolarization and refractory period. Cardiovasc Res, 50:10–23.

Carmeliet E. 1999. Cardiac ionic currents and acute ischemia : From channels to arrythmias. Physiol Rev, 79:917-1017.

Antzelevitch C., Viskin S., Shimizu W., Yan G.X., Kowey P., Zhang L., et al. 2007. Does Tpeak – Tend provide an index of transmural dispersion of repolarization? Heart Rhythm, 4:1114- 1119.

Jiang X., Zhao H., Ji Z., Liu G., Liu L. 2013. The correlation of t peak-t end interval and ventricular arrhythmia in patients with acute myocardial infarction. Tianjin Med J, 41:740-743.

Chesebro J.H., Knatterud G., Roberts R., Borer J., Cohen L.S., Dalen J., et al. 1987. Thrombolysis in Myocardial Infarction (TIMI) Trial, Phase I: A comparison between intravenous tissue plasminogen activator and intravenous streptokinase. Clinical findings through hospital discharge. Circulation, 76:142- 154.

van 't Hof A.W., Liem A., Suryapranata H., Hoorntje J.C., de Boer M.J., Zijlstra F.1997. Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for

acute myocardial infarction : myocardial blush grade . Zwolle myocardial infarction study group. Circulation, 97:2302-6.

Gibson C.M., Schomig, A. 2004. Coronary and myocardial angiography: angiographic assessment of both epicardial and myocardial perfusion. Circulation, 109:3096-3105.

Vogelzang M., Vlaar P.J., Svilaas T., Amo D., Nijsten, M.W., Zijlstra,F. 2009. Computer assisted myocardial blush quantification after percutaneous coronary angioplasty for acute myocardial infarction: A substudy from the TAPAS trial. Eur Heart J. 30:594-599

Haarmark C., Graff C., Andersen M.P., Hardahl T., Struijk J.J., Toft E., et al. 2010. Reference value of electrocardiogram repolarization variables in a healthy population. J Electrocardiol, 43:31-39.

Mikelsone I., Bormane I., Simsone Z., Jurka A., Tretjakovs P. 2011. The effect of chronic cigarette smoking on microvascular function, insulin resistance and inflamatory state. Environ and Exp Biology, 9:23-28.

Melandri G., Branzi A., Semprini F., Cervi V., Galie N., Magnani B. 1990. Enhanced thrombolytic efficacy and reduction of infarct size by infusion of streptokinase and heparin. Br Heart J, 64:118-120.

Morrison L.J., Verbeek P.R., McDonald A.C., Sawadsky B.V., Cook D.J. 2000. Mortality and pre hospital thrombolysis for acute myocardial infarction; A-meta analysis. JAMA, 283:2686-2692.

Shentar J., Deora S., Rai M., Nanjappa M.C. 2015. Prolonged t peak-end and t peak end/qt ratio as perdictors of malignant ventricular arrythmias in the acute phase of st segment elevation myocardial infarction : a prospective case-control study. Heart Rhythm, 12:484-489.

Gupta P., Patel C., Narayanaswamy S., Malhotra B., Green J.T, Yang G.X. 2008.Tp-e/QT ratio as an index of arrythmogenesis. J Electrocardiol, 41:567-574.

Niccoli G., Scalone G., Lerman A., Crea F. 2016. Coronary microvascular obstruction in acute myocardial infarction. Circulation, 37:1024-1033.

Porto I., Hamilton-Craig C., Brancati M., Burzotta F., Galiuto L. 2010. Angiographic assesment of microvascular perfusion – Myocardial blush in clinical practice. Am Heart J, 160:1015-1022.

Capaldo B., Galderisi M., Turco A.A., D’errico A., Turco S., Rivellse A.A., et al. 2005. Hyperglycemia does not affect the reactivity of coronary microcirculation in humans. J Clin Endocrinol Metab. 90:3871-3876.

Campbell D.J., Somaratne J.B., Prior D.L., Kenny J.F., Newcomb A.E., Kelly D.J. 2013. Obesity is associated with lower coronary microvascular density. Ann Intern Med, 1:e8179-e8198.

Gullu H., Caliskan M., Ciftci O., Erdogan D., Topcu S., Yildirim E., et al. 2006. Light cigarette smoking impairs coronary microvascular functions as severely as smoking regular cigarettes. Heart, 93:1274-1277

DOI: https://doi.org/10.22146/aci.40849