Electrocardiographic markers of arrhythmogenic risk in patients with isolated coronary artery ectasia

Background

Coronary artery ectasia (CAE) is an uncommon finding with potential clinical implications, including arrhythmogenic risk. Electrocardiographic parameters such as QT dispersion (QTd) and P wave dispersion (PWD) have been proposed as non-invasive predictors of electrical instability. This study aimed to compare ECG findings, between patients with isolated CAE and those with normal coronary arteries.

Methods

In this case-control study, 23 patients with isolated CAE (Group 1) and 26 patients with angiographically normal coronary arteries (Group 2) were enrolled. Groups were matched for age, gender, cardiovascular risk factors, and ejection fraction. Patients with conditions or medications affecting conduction were excluded. ECG parameters were compared using Chi-square and unpaired t-tests. Additional subgroup analyses using ANOVA, Spearman correlation, and linear mixed models were performed.

Results

T wave inversion was significantly more common in Group 1 than Group 2 (52.2 % vs. 11.5 %, P = 0.006). QTc was significantly prolonged in Group 1 (P = 0.046). QTd, QTcd, and PWD were all significantly greater in Group 1 (P < 0.05). QTd, QTcd, and PWD were positively correlated with the number of ectatic vessels (P < 0.001). However, PR interval, QRS duration, and QTc did not show significant associations. ECG parameters did not significantly differ based on the specific ectatic vessel. Significant variation in QTd, QTcd, and PWD was observed across different Markis types.

Conclusions

Patients with isolated CAE exhibit greater QT dispersion and P wave dispersion compared to controls, suggesting a higher arrhythmogenic potential. These parameters also correlate with the extent and classification of ectasia, highlighting their potential utility in risk stratification.