Electrocardiographic predictors of coronary microvascular dysfunction in patients with non-obstructive coronary artery disease: Utility of a novel T wave analysis program

Abstract

BackgroundCoronary microvascular dysfunction (CMD) is linked to adverse cardiovascular events. Definitive diagnosis of CMD requires invasive provocative testing during angiography. We developed and tested a novel computerized T wave analysis tool to identify electrocardiographic signatures of CMD. Methods1552 patients underwent an invasive assessment of coronary microvascular function. Patients with interpretable pre-procedural ECGs were divided into 2 age and sex matched groups (n=261 in each group, 75% female): normal microvascular function, CFR>2.5 (CFR+), and abnormal microvascular function, CFR≤2.5 (CFR−). ECGs were evaluated using a novel T wave program that quantified subtle changes in T wave morphology. ResultsT wave repolarization parameters were significantly different between patients with normal and abnormal microvascular function. The top 3 features in males comprised of T wave area in V6 (CFR+: 10091.4mV2 vs. CFR−: 8152.3mV2, p<0.05); T1 Y-center of gravity in lead II (CFR+: 17.8mV vs. CFR−: 22.4, p<0.005) and T Peak-T End in lead II (CFR+: 97.6msec vs. CFR−: 91.1msec, p<0.05). These could identify the presence of an abnormal CFR with 74±0.2% accuracy. In females, the top 3 features were T wave right slope lead V6 (CFR+: −2489.1mV/msec vs. CFR−: −2352.3mV/msec, p<0.005); Amplitude in V6 (CFR+: 190.4mV vs. 172.7mV, p=0.05) and Y-center of gravity in lead V1 (CFR+: 33.3 vs. CFR−: 40.0, p=0.001). These features could identify the presence of an abnormal CFR with 67±0.3% accuracy. ConclusionOur data demonstrates that a computer-based repolarization measurement tool may identify electrocardiographic signatures of CMD.