title: Electrocardiographic predictors of coronary microvascular dysfunction in patients with non-obstructive coronary artery disease: Utility of a novel T wave analysis program.
abstract: BACKGROUND
  Coronary 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.
  
  
  METHODS
  1552 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.
  
  
  RESULTS
  T 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+: 10091.4 mV(2) vs. CFR-: 8152.3 mV(2), p<0.05); T1 Y-center of gravity in lead II (CFR+: 17.8 mV vs. CFR-: 22.4, p<0.005) and T Peak-T End in lead II (CFR+: 97.6 msec vs. CFR-: 91.1 msec, 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+: -2489.1 mV/msec vs. CFR-: -2352.3 mV/msec, p<0.005); Amplitude in V6 (CFR+: 190.4 mV vs. 172.7 mV, 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.
  
  
  CONCLUSIONS
  Our data demonstrates that a computer-based repolarization measurement tool may identify electrocardiographic signatures of CMD.
authors.affiliation: Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN, USA.
authors.forename: Jaskanwal D
authors.initials: JD
authors.lastname: Sara
authors.affiliation: Division of Internal Medicine, Mayo College of Medicine, Rochester, MN, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Sugrue
authors.affiliation: Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN, USA; Czech Institute of Informatics, Robotics, and Cybernetics, Czech Technical University in Prague, Czech Republic.
authors.forename: Vaclav
authors.initials: V
authors.lastname: Kremen
authors.affiliation: Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN, USA.
authors.forename: Bo
authors.initials: B
authors.lastname: Qiang
authors.affiliation: Electrical and Computer Engineering, Ben-Gurion University of the Negev, Beer Sheva, Israel.
authors.forename: Yehu
authors.initials: Y
authors.lastname: Sapir
authors.affiliation: Electrical and Computer Engineering, Ben-Gurion University of the Negev, Beer Sheva, Israel.
authors.forename: Zachi I
authors.initials: ZI
authors.lastname: Attia
authors.affiliation: Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Ackerman
authors.affiliation: Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN, USA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
authors.affiliation: Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN, USA.
authors.forename: Amir
authors.initials: A
authors.lastname: Lerman
authors.affiliation: Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN, USA. Electronic address: noseworthy.peter@mayo.edu.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Noseworthy
mesh_terms: D001783:Blood Flow Velocity; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology; D003326:Coronary Circulation / Q000502:physiology*; D003331:Coronary Vessels / Q000503:physiopathology*; D004562:Electrocardiography / Q000379:methods*; D001330:Electronic Data Processing / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012984:Software; D018084:Ultrasonography, Interventional
keywords: Coronary microvascular dysfunction; Non-obstructive coronary artery disease; QT interval prolongation; T wave morphology; Ventricular arrhythmia