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Published in: Heart and Vessels 4/2011

01-07-2011 | Original Article

The effects of perindopril on QT duration and dispersion in patients with coronary slow flow

Authors: Unal Guntekin, Hasan Ali Gumrukcuoglu, Yilmaz Gunes, Ahmet Gunes, Hakki Simsek, Musa Sahin, Yusuf Sezen, Serkan Akdağ, Mustafa Tuncer

Published in: Heart and Vessels | Issue 4/2011

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Abstract

Coronary slow flow (CSF) is characterized by delayed opacification of coronary arteries in the absence epicardial occlusive disease. QT duration and dispersion have been reported to be longer in patients with CSF. ACE inhibitors may improve CSF through positive effects on endothelial function. The study included 32 patients having CSF and 25 subjects having normal coronary arteries in coronary angiography. The patients were evaluated with 12-leads electrocardiography and echocardiography before and 3 months after treatment with perindopril. Compared to the control group, maximum corrected QT duration (QTcmax) (432.0 ± 28.9 vs. 407.0 ± 39.1 ms, p = 0.008) and QT dispersion (QTcD) (64.0 ± 16.5 vs. 37.3 ± 12.1 ms, p < 0.001), mitral inflow deceleration time (DT) (251.3 ± 49.4 vs. 218.8 ± 44.5 ms, p = 0.013), and isovolumetric relaxation time (IVRT) (115.8 ± 18.4 vs. 107.2 ± 22.9 ms, p < 0.001) were significantly longer and E/A ratio 0.85 ± 0.2 vs. 1.1 ± 0.3, p = 0.004) was lower in patients with CSF. QTcmax (to 407.0 ± 28.0 ms, p = 0.001), QTcD (to 44.5 ± 11.4 ms, p < 0.001), DT (to 221.6 ± 37.7 ms, p < 0.001) and IVRT (to 103.8 ± 16.1 ms, p < 0.001) were significantly decreased and E/A ratio (to 0.98 ± 0.3, p < 0.001) was significantly increased after treatment with perindopril. Coronary slow may be associated with prolonged QT interval and increased QT dispersion and impaired diastolic filling. Perindopril may be helpful in restoration of these findings.
Literature
1.
go back to reference Tambe AA, Demany MA, Zimmerman HA, Mascarenhas E (1972) Angina pectoris and slow flow velocity of dye in coronary arteries––a new angiographic finding. Am Heart J 84:66–71PubMedCrossRef Tambe AA, Demany MA, Zimmerman HA, Mascarenhas E (1972) Angina pectoris and slow flow velocity of dye in coronary arteries––a new angiographic finding. Am Heart J 84:66–71PubMedCrossRef
2.
go back to reference Singh S, Kothari SS, Bahl VK (2004) Coronary slow flow phenomenon: an angiographic curiosity. Indian Heart J 56:613–617PubMed Singh S, Kothari SS, Bahl VK (2004) Coronary slow flow phenomenon: an angiographic curiosity. Indian Heart J 56:613–617PubMed
3.
go back to reference Pekdemir H, Cin VG, Cicek D, Camsari A, Akkus N, Döven O, Parmaksiz HT (2004) Slow coronary flow may be a sign of diffuse atherosclerosis. Contribution of FFR and IVUS. Acta Cardiol 59:127–133PubMedCrossRef Pekdemir H, Cin VG, Cicek D, Camsari A, Akkus N, Döven O, Parmaksiz HT (2004) Slow coronary flow may be a sign of diffuse atherosclerosis. Contribution of FFR and IVUS. Acta Cardiol 59:127–133PubMedCrossRef
4.
go back to reference Mangieri E, Macchiarelli G, Ciavolella M, Barillà F, Avella A, Martinotti A, Dell’Italia LJ, Scibilia G, Motta P, Campa PP (1996) Slow coronary flow: clinical and histopathological features in patients with otherwise normal epicardial coronary arteries. Cathet Cardiovasc Diagn 37:375–381PubMedCrossRef Mangieri E, Macchiarelli G, Ciavolella M, Barillà F, Avella A, Martinotti A, Dell’Italia LJ, Scibilia G, Motta P, Campa PP (1996) Slow coronary flow: clinical and histopathological features in patients with otherwise normal epicardial coronary arteries. Cathet Cardiovasc Diagn 37:375–381PubMedCrossRef
5.
go back to reference Beltrame JF, Limaye SB, Horowitz JD (2002) The coronary slow flow phenomenon––a new coronary microvascular disorder. Cardiology 97:197–202PubMedCrossRef Beltrame JF, Limaye SB, Horowitz JD (2002) The coronary slow flow phenomenon––a new coronary microvascular disorder. Cardiology 97:197–202PubMedCrossRef
7.
go back to reference Day CP, Mc Comb JM, Campbell PWF (1990) QT dispersion. An indication of arrhythmia risk in patients with long QT. Br Heart J 63:342–344PubMedCrossRef Day CP, Mc Comb JM, Campbell PWF (1990) QT dispersion. An indication of arrhythmia risk in patients with long QT. Br Heart J 63:342–344PubMedCrossRef
8.
go back to reference Janse MJ, Wit AL (1989) Electrophysiological mechanisms of ventricular arrhythmias resulting from myocardial ischemia and infarction. Physiol Rev 69:1049–1069PubMed Janse MJ, Wit AL (1989) Electrophysiological mechanisms of ventricular arrhythmias resulting from myocardial ischemia and infarction. Physiol Rev 69:1049–1069PubMed
9.
go back to reference Yaymaci B, Dagdelen S, Bozbuga N, Demirkol O, Say B, Guzelmeric F, Dindar I (2001) The response of the myocardial metabolism to atrial pacing in patients with coronary slow flow. Int J Cardiol 78:151–156PubMedCrossRef Yaymaci B, Dagdelen S, Bozbuga N, Demirkol O, Say B, Guzelmeric F, Dindar I (2001) The response of the myocardial metabolism to atrial pacing in patients with coronary slow flow. Int J Cardiol 78:151–156PubMedCrossRef
10.
go back to reference César LA, Ramires JA, Serrano Júnior CV, Meneghetti JC, Antonelli RH, da-Luz PL, Pileggi FJ (1996) Slow coronary run-off in patients with angina pectoris: clinical significance and thallium-201 scintigraphic study. Braz J Med Biol Res 29:605–613PubMed César LA, Ramires JA, Serrano Júnior CV, Meneghetti JC, Antonelli RH, da-Luz PL, Pileggi FJ (1996) Slow coronary run-off in patients with angina pectoris: clinical significance and thallium-201 scintigraphic study. Braz J Med Biol Res 29:605–613PubMed
11.
go back to reference Sporton SC, Taggart P, Sutton PM, Walker JM, Hardman SM (1997) Acute ischemia: a dynamic influence on QT dispersion. Lancet 349:306–309PubMedCrossRef Sporton SC, Taggart P, Sutton PM, Walker JM, Hardman SM (1997) Acute ischemia: a dynamic influence on QT dispersion. Lancet 349:306–309PubMedCrossRef
12.
go back to reference Atak R, Turhan H, Sezgin AT, Yetkin O, Senen K, Ileri M, Sahin O, Karabal O, Yetkin E, Kutuk E, Demirkan D (2003) Effects of slow coronary artery flow on QT interval duration and dispersion. Ann Noninvasive Electrocardiol 8:107–111PubMedCrossRef Atak R, Turhan H, Sezgin AT, Yetkin O, Senen K, Ileri M, Sahin O, Karabal O, Yetkin E, Kutuk E, Demirkan D (2003) Effects of slow coronary artery flow on QT interval duration and dispersion. Ann Noninvasive Electrocardiol 8:107–111PubMedCrossRef
13.
go back to reference Sezgin AT, Barutcu I, Ozdemir R, Gullu H, Topal E, Esen AM, Tandogan I, Acikgoz N (2007) Effect of slow coronary flow on electrocardiographic parameters reflecting ventricular heterogeneity. Angiology 58:289–294PubMedCrossRef Sezgin AT, Barutcu I, Ozdemir R, Gullu H, Topal E, Esen AM, Tandogan I, Acikgoz N (2007) Effect of slow coronary flow on electrocardiographic parameters reflecting ventricular heterogeneity. Angiology 58:289–294PubMedCrossRef
14.
go back to reference Sezgin AT, Sigirci A, Barutcu I, Topal E, Sezgin N, Ozdemir R, Yetkin E, Tandogan I, Kosar F, Ermis N, Yologlu S, Bariskaner E, Cehreli S (2003) Vascular endothelial function in patients with slow coronary flow. Coronary Artery Dis 14:155–161CrossRef Sezgin AT, Sigirci A, Barutcu I, Topal E, Sezgin N, Ozdemir R, Yetkin E, Tandogan I, Kosar F, Ermis N, Yologlu S, Bariskaner E, Cehreli S (2003) Vascular endothelial function in patients with slow coronary flow. Coronary Artery Dis 14:155–161CrossRef
15.
go back to reference Hornig B, Kohler C, Drexler H (1997) Role of bradykinin in mediating vascular effects of angiotensin-converting enzyme inhibitors in humans. Circulation 95:1115–1118PubMed Hornig B, Kohler C, Drexler H (1997) Role of bradykinin in mediating vascular effects of angiotensin-converting enzyme inhibitors in humans. Circulation 95:1115–1118PubMed
16.
go back to reference Zhuo JL, Mendelsohn FA, Ohishi M (2002) Perindopril alters vascular angiotensin-converting enzyme, AT(1) receptor, and nitric oxide synthase expression in patients with coronary heart disease. Hypertension 39:634–638PubMedCrossRef Zhuo JL, Mendelsohn FA, Ohishi M (2002) Perindopril alters vascular angiotensin-converting enzyme, AT(1) receptor, and nitric oxide synthase expression in patients with coronary heart disease. Hypertension 39:634–638PubMedCrossRef
17.
go back to reference Gibson CM, Cannon CP, Daley WL, Dodge JT Jr, Alexander B Jr, Marble SJ, McCabe CH, Raymond L, Fortin T, Poole WK, Braunwald E (1996) TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation 93:879–883PubMed Gibson CM, Cannon CP, Daley WL, Dodge JT Jr, Alexander B Jr, Marble SJ, McCabe CH, Raymond L, Fortin T, Poole WK, Braunwald E (1996) TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation 93:879–883PubMed
18.
go back to reference Chamber Quantification Writing Group; American Society of Echocardiography’s Guidelines, Standards Committee (2005) European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463CrossRef Chamber Quantification Writing Group; American Society of Echocardiography’s Guidelines, Standards Committee (2005) European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463CrossRef
19.
go back to reference Lanjewar P, Pathak V, Lokhandwala Y (2004) Issues in QT interval measurement. Indian Pacing Electrophysiol J 4:156–161PubMed Lanjewar P, Pathak V, Lokhandwala Y (2004) Issues in QT interval measurement. Indian Pacing Electrophysiol J 4:156–161PubMed
20.
go back to reference Mosseri M, Yarom R, Gotsman MS, Hasin Y (1986) Histologic evidence for small vessel coronary disease in patients with angina pectoris and patent large coronary arteries. Circulation 74:964–972PubMedCrossRef Mosseri M, Yarom R, Gotsman MS, Hasin Y (1986) Histologic evidence for small vessel coronary disease in patients with angina pectoris and patent large coronary arteries. Circulation 74:964–972PubMedCrossRef
21.
go back to reference Selcuk H, Selcuk MT, Temizhan A, Maden O, Saydam GS, Ulupinar H, Dogan M, Aydin C, Topcu DI, Sasmaz A (2009) Decreased plasma concentrations of adiponectin in patients with slow coronary flow. Heart Vessels 1:1–7CrossRef Selcuk H, Selcuk MT, Temizhan A, Maden O, Saydam GS, Ulupinar H, Dogan M, Aydin C, Topcu DI, Sasmaz A (2009) Decreased plasma concentrations of adiponectin in patients with slow coronary flow. Heart Vessels 1:1–7CrossRef
22.
go back to reference Pye M, Quinn AC, Cobbe SM (1994) QT interval dispersion. A non-invasive marker of susceptibility to arrhythmia in patients with sustained ventricular arrhythmias? Br Heart J 71:511–514PubMedCrossRef Pye M, Quinn AC, Cobbe SM (1994) QT interval dispersion. A non-invasive marker of susceptibility to arrhythmia in patients with sustained ventricular arrhythmias? Br Heart J 71:511–514PubMedCrossRef
23.
go back to reference Zarebe W, Moss AJ, le Cessie S (1994) Dispersion of ventricular repolarization and arrhythmic cardiac death in coronary artery disease. Am J Cardiol 74:550–553CrossRef Zarebe W, Moss AJ, le Cessie S (1994) Dispersion of ventricular repolarization and arrhythmic cardiac death in coronary artery disease. Am J Cardiol 74:550–553CrossRef
24.
go back to reference Barr CS, Naas A, Freeman M, Lang CC, Struthers AD (1994) QT dispersion and sudden unexpected death in chronic heart failure. Lancet 343:327–329PubMedCrossRef Barr CS, Naas A, Freeman M, Lang CC, Struthers AD (1994) QT dispersion and sudden unexpected death in chronic heart failure. Lancet 343:327–329PubMedCrossRef
25.
go back to reference Stierle U, Giannitsis E, Sheikhzadeh A, Krüger D, Schmücker G, Mitusch R, Potratz J (1998) Relation between QT dispersion and the extent of myocardial ischemia in patients with three-vessel coronary artery disease. Am J Cardiol 81:564–568PubMedCrossRef Stierle U, Giannitsis E, Sheikhzadeh A, Krüger D, Schmücker G, Mitusch R, Potratz J (1998) Relation between QT dispersion and the extent of myocardial ischemia in patients with three-vessel coronary artery disease. Am J Cardiol 81:564–568PubMedCrossRef
26.
go back to reference Roukema G, Singh JP, Meijs M, Carvalho C, Hart G (1998) Effect of exercise-induced ischemia on QT interval dispersion. Am Heart J 135:88–92PubMedCrossRef Roukema G, Singh JP, Meijs M, Carvalho C, Hart G (1998) Effect of exercise-induced ischemia on QT interval dispersion. Am Heart J 135:88–92PubMedCrossRef
27.
go back to reference Przybojewski J, Becker PH (1986) Angina pectoris and acute myocardial infarction due to “slow-flow phenomenon” in nonatherosclerotic coronary arteries. A case report. Angiology 37:751–761PubMedCrossRef Przybojewski J, Becker PH (1986) Angina pectoris and acute myocardial infarction due to “slow-flow phenomenon” in nonatherosclerotic coronary arteries. A case report. Angiology 37:751–761PubMedCrossRef
28.
go back to reference Kapoor A, Goel PK, Gupta SK (1998) Slow coronary flow-a cause for angina with ST segment elevation and normal coronary arteries. A case report. Int J Cardiol 67:257–261PubMedCrossRef Kapoor A, Goel PK, Gupta SK (1998) Slow coronary flow-a cause for angina with ST segment elevation and normal coronary arteries. A case report. Int J Cardiol 67:257–261PubMedCrossRef
29.
go back to reference Diver DJ, Bier JD, Ferreira PE, Sharaf BL, McCabe C, Thompson B, Chaitman B, Williams DO, Braunwald E (1994) Clinical and arteriographic characterization of patients with unstable angina without critical coronary arterial narrowing (from the TIMI-IIIA Trial). Am J Cardiol 74:531–537PubMedCrossRef Diver DJ, Bier JD, Ferreira PE, Sharaf BL, McCabe C, Thompson B, Chaitman B, Williams DO, Braunwald E (1994) Clinical and arteriographic characterization of patients with unstable angina without critical coronary arterial narrowing (from the TIMI-IIIA Trial). Am J Cardiol 74:531–537PubMedCrossRef
30.
go back to reference Yazici M, Demircan S, Durna K, Sahin M (2007) The role of adrenergic activity in slow flow coronary flow and its relationship to TIMI frame count. Angiology 58:393–400PubMedCrossRef Yazici M, Demircan S, Durna K, Sahin M (2007) The role of adrenergic activity in slow flow coronary flow and its relationship to TIMI frame count. Angiology 58:393–400PubMedCrossRef
31.
go back to reference Ishida S, Nakagawa M, Fujino T, Yonemochi H, Saikawa T, Ito M (1997) Circadian variation of QT interval dispersion: correlation with heart rate variability. J Electrocardiol 30:205–210PubMedCrossRef Ishida S, Nakagawa M, Fujino T, Yonemochi H, Saikawa T, Ito M (1997) Circadian variation of QT interval dispersion: correlation with heart rate variability. J Electrocardiol 30:205–210PubMedCrossRef
32.
go back to reference Sezgin AT, Topal E, Barutcu I, Ozdemir R, Gullu H, Bariskaner E, Ermis N, Tandogan I, Acikgoz N, Sivri N (2005) Impaired left ventricle filling in slow coronary flow phenomenon: an echo-Doppler study. Angiology 56:397–401PubMedCrossRef Sezgin AT, Topal E, Barutcu I, Ozdemir R, Gullu H, Bariskaner E, Ermis N, Tandogan I, Acikgoz N, Sivri N (2005) Impaired left ventricle filling in slow coronary flow phenomenon: an echo-Doppler study. Angiology 56:397–401PubMedCrossRef
33.
go back to reference Sevimli S, Büyükkaya E, Gündoğdu F, Arslan S, Aksakal E, Gürlertop Y, Ateşal S (2007) Left ventricular function in patients with coronary slow flow: a tissue Doppler study. Arch Turkh Soc Cardiol 35:360–365 Sevimli S, Büyükkaya E, Gündoğdu F, Arslan S, Aksakal E, Gürlertop Y, Ateşal S (2007) Left ventricular function in patients with coronary slow flow: a tissue Doppler study. Arch Turkh Soc Cardiol 35:360–365
34.
go back to reference Szymański P, Swiatkowski M, Rezler J, Budaj A (1999) The relationship between diastolic function of the left ventricle and QT dispersion in patients with myocardial infarction. Int J Cardiol 69:245–249PubMedCrossRef Szymański P, Swiatkowski M, Rezler J, Budaj A (1999) The relationship between diastolic function of the left ventricle and QT dispersion in patients with myocardial infarction. Int J Cardiol 69:245–249PubMedCrossRef
35.
go back to reference Sporton SC, Taggart P, Sutton PM, Walker JM, Hardman SM (1997) Acute ischaemia: a dynamic influence on QT dispersion. Lancet 349:306–309PubMedCrossRef Sporton SC, Taggart P, Sutton PM, Walker JM, Hardman SM (1997) Acute ischaemia: a dynamic influence on QT dispersion. Lancet 349:306–309PubMedCrossRef
36.
go back to reference Perrone FP, Bacharach SL, Dilsizian V, Bonow RO (1991) Impaired left ventricular filling and regional diastolic asynchrony at rest in coronary artery disease and relation to exercise-induced myocardial ischemia. Am J Cardiol 67:356–360CrossRef Perrone FP, Bacharach SL, Dilsizian V, Bonow RO (1991) Impaired left ventricular filling and regional diastolic asynchrony at rest in coronary artery disease and relation to exercise-induced myocardial ischemia. Am J Cardiol 67:356–360CrossRef
37.
go back to reference Scientific Committee of the PERTINENT Sub-Study, EUROPA-PERTINENT Investigators (2003) PERTINENT––perindopril-thrombosis, inflammation, endothelial dysfunction and neurohormonal activation trial: a sub-study of the EUROPA study. Cardiovasc Drugs Ther 17:83–91CrossRef Scientific Committee of the PERTINENT Sub-Study, EUROPA-PERTINENT Investigators (2003) PERTINENT––perindopril-thrombosis, inflammation, endothelial dysfunction and neurohormonal activation trial: a sub-study of the EUROPA study. Cardiovasc Drugs Ther 17:83–91CrossRef
38.
go back to reference Bots ML, Remme WJ, Lüscher TF, Grobbee DE (2002) EUROPA-PERFECT Investigators Perindopril-Function of the Endothelium in Coronary Artery Disease Trial: the PERFECT study–sub study of EUROPA: rationale and design. Cardiovasc Drugs Ther 16:227–236PubMedCrossRef Bots ML, Remme WJ, Lüscher TF, Grobbee DE (2002) EUROPA-PERFECT Investigators Perindopril-Function of the Endothelium in Coronary Artery Disease Trial: the PERFECT study–sub study of EUROPA: rationale and design. Cardiovasc Drugs Ther 16:227–236PubMedCrossRef
Metadata
Title
The effects of perindopril on QT duration and dispersion in patients with coronary slow flow
Authors
Unal Guntekin
Hasan Ali Gumrukcuoglu
Yilmaz Gunes
Ahmet Gunes
Hakki Simsek
Musa Sahin
Yusuf Sezen
Serkan Akdağ
Mustafa Tuncer
Publication date
01-07-2011
Publisher
Springer Japan
Published in
Heart and Vessels / Issue 4/2011
Print ISSN: 0910-8327
Electronic ISSN: 1615-2573
DOI
https://doi.org/10.1007/s00380-010-0058-4

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