Electrocardiographic changes in coronary endothelial dysfunction

Gautam Kumar, Kyle W. Klarich, Nicole D. Collett, Amir Lerman

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective Coronary endothelial dysfunction is the early stage of coronary artery disease. We documented the incidence and type of electrocardiographic changes during acetylcholine-induced coronary endothelial dysfunction. Methods Endothelial function studies were performed with intracoronary injections of 10-6, 10-5, and 10-4 mmol/l acetylcholine. Twelve-lead electrocardiograms were obtained at baseline, after each acetylcholine injection, and at the end of the procedure. Exclusion criteria included use of nitroglycerin within the previous 24h, coronary artery disease with stenosis of more than 30% of the luminal diameter, intolerance to acetylcholine injection, and patient age younger than 18 years. Of the 75 patients enrolled, six were excluded, and 69 were analyzed (69.6% female, 30.4% male; mean age, 47.8 years). Results Among the 69 patients, 11.6% had right bundle branch block and 4.3% had left anterior fascicular block; one had left ventricular hypertrophy by voltage criteria, and five had electrocardiographic changes during acetylcholine injection: one had inferior ST-segment elevations, three had T-wave inversions, and one had resolution of baseline T-wave inversions. Only one of these five patients had periprocedural chest pain; it was associated with a decrease in coronary artery diameter (P<0.05). QT and corrected QT intervals were prolonged after acetylcholine administration (P<0.05). An increase of 10 ms or more in the corrected QT interval was associated with a greater increase in coronary artery blood flow (P<0.05) and a smaller decrease in coronary artery diameter (P<0.05). Conclusion For the diagnosis of coronary endothelial dysfunction, invasive studies should be conducted even if electrocardiograms during chest pain were negative.

Original languageEnglish (US)
Pages (from-to)395-398
Number of pages4
JournalCoronary Artery Disease
Volume19
Issue number6
DOIs
StatePublished - Sep 2008

Fingerprint

Acetylcholine
Coronary Vessels
Injections
Bundle-Branch Block
Chest Pain
Coronary Artery Disease
Electrocardiography
Nitroglycerin
Left Ventricular Hypertrophy
Pathologic Constriction
Incidence

Keywords

  • Acetylcholine
  • Coronary artery disease
  • Electrocardiogram
  • Endothelial dysfunction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Electrocardiographic changes in coronary endothelial dysfunction. / Kumar, Gautam; Klarich, Kyle W.; Collett, Nicole D.; Lerman, Amir.

In: Coronary Artery Disease, Vol. 19, No. 6, 09.2008, p. 395-398.

Research output: Contribution to journalArticle

Kumar, Gautam ; Klarich, Kyle W. ; Collett, Nicole D. ; Lerman, Amir. / Electrocardiographic changes in coronary endothelial dysfunction. In: Coronary Artery Disease. 2008 ; Vol. 19, No. 6. pp. 395-398.
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abstract = "Objective Coronary endothelial dysfunction is the early stage of coronary artery disease. We documented the incidence and type of electrocardiographic changes during acetylcholine-induced coronary endothelial dysfunction. Methods Endothelial function studies were performed with intracoronary injections of 10-6, 10-5, and 10-4 mmol/l acetylcholine. Twelve-lead electrocardiograms were obtained at baseline, after each acetylcholine injection, and at the end of the procedure. Exclusion criteria included use of nitroglycerin within the previous 24h, coronary artery disease with stenosis of more than 30{\%} of the luminal diameter, intolerance to acetylcholine injection, and patient age younger than 18 years. Of the 75 patients enrolled, six were excluded, and 69 were analyzed (69.6{\%} female, 30.4{\%} male; mean age, 47.8 years). Results Among the 69 patients, 11.6{\%} had right bundle branch block and 4.3{\%} had left anterior fascicular block; one had left ventricular hypertrophy by voltage criteria, and five had electrocardiographic changes during acetylcholine injection: one had inferior ST-segment elevations, three had T-wave inversions, and one had resolution of baseline T-wave inversions. Only one of these five patients had periprocedural chest pain; it was associated with a decrease in coronary artery diameter (P<0.05). QT and corrected QT intervals were prolonged after acetylcholine administration (P<0.05). An increase of 10 ms or more in the corrected QT interval was associated with a greater increase in coronary artery blood flow (P<0.05) and a smaller decrease in coronary artery diameter (P<0.05). Conclusion For the diagnosis of coronary endothelial dysfunction, invasive studies should be conducted even if electrocardiograms during chest pain were negative.",
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N2 - Objective Coronary endothelial dysfunction is the early stage of coronary artery disease. We documented the incidence and type of electrocardiographic changes during acetylcholine-induced coronary endothelial dysfunction. Methods Endothelial function studies were performed with intracoronary injections of 10-6, 10-5, and 10-4 mmol/l acetylcholine. Twelve-lead electrocardiograms were obtained at baseline, after each acetylcholine injection, and at the end of the procedure. Exclusion criteria included use of nitroglycerin within the previous 24h, coronary artery disease with stenosis of more than 30% of the luminal diameter, intolerance to acetylcholine injection, and patient age younger than 18 years. Of the 75 patients enrolled, six were excluded, and 69 were analyzed (69.6% female, 30.4% male; mean age, 47.8 years). Results Among the 69 patients, 11.6% had right bundle branch block and 4.3% had left anterior fascicular block; one had left ventricular hypertrophy by voltage criteria, and five had electrocardiographic changes during acetylcholine injection: one had inferior ST-segment elevations, three had T-wave inversions, and one had resolution of baseline T-wave inversions. Only one of these five patients had periprocedural chest pain; it was associated with a decrease in coronary artery diameter (P<0.05). QT and corrected QT intervals were prolonged after acetylcholine administration (P<0.05). An increase of 10 ms or more in the corrected QT interval was associated with a greater increase in coronary artery blood flow (P<0.05) and a smaller decrease in coronary artery diameter (P<0.05). Conclusion For the diagnosis of coronary endothelial dysfunction, invasive studies should be conducted even if electrocardiograms during chest pain were negative.

AB - Objective Coronary endothelial dysfunction is the early stage of coronary artery disease. We documented the incidence and type of electrocardiographic changes during acetylcholine-induced coronary endothelial dysfunction. Methods Endothelial function studies were performed with intracoronary injections of 10-6, 10-5, and 10-4 mmol/l acetylcholine. Twelve-lead electrocardiograms were obtained at baseline, after each acetylcholine injection, and at the end of the procedure. Exclusion criteria included use of nitroglycerin within the previous 24h, coronary artery disease with stenosis of more than 30% of the luminal diameter, intolerance to acetylcholine injection, and patient age younger than 18 years. Of the 75 patients enrolled, six were excluded, and 69 were analyzed (69.6% female, 30.4% male; mean age, 47.8 years). Results Among the 69 patients, 11.6% had right bundle branch block and 4.3% had left anterior fascicular block; one had left ventricular hypertrophy by voltage criteria, and five had electrocardiographic changes during acetylcholine injection: one had inferior ST-segment elevations, three had T-wave inversions, and one had resolution of baseline T-wave inversions. Only one of these five patients had periprocedural chest pain; it was associated with a decrease in coronary artery diameter (P<0.05). QT and corrected QT intervals were prolonged after acetylcholine administration (P<0.05). An increase of 10 ms or more in the corrected QT interval was associated with a greater increase in coronary artery blood flow (P<0.05) and a smaller decrease in coronary artery diameter (P<0.05). Conclusion For the diagnosis of coronary endothelial dysfunction, invasive studies should be conducted even if electrocardiograms during chest pain were negative.

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