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Nakayama M, Matsuo H, Sato T, Okabe M, Aizawa Y. Is ischemic stimulus involved for J wave augmentation during coronary angiography and intracoronary administration of normal saline? Pacing Clin Electrophysiol 2024. [PMID: 38852066 DOI: 10.1111/pace.15005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/02/2024] [Accepted: 05/10/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND J waves may be augmented by coronary angiography (CAG) or intracoronary drug administration but the underlying mechanism is unknown. PURPOSE The effect of intracoronary normal saline (NS) on J waves were investigated. PATIENTS AND METHODS After the standard CAG using iopamidol (IopamiroR Inj), NS was injected into the right coronary artery in 10 patients with and eight patients without J waves at the baseline. The 12-lead ECG was monitored, stored on a computer and retrieved later for measurement of the J wave amplitude before or during the coronary interventions. RESULTS J waves in leads II, III and aVF at baseline increased significantly in each lead during the right CAG and NS injection into the right coronary artery. The J wave changes were similar between the two interventions and distinct similar alterations were observed in the QRS complex. We postulated that the ischemic myocardium that was induced during CAG or intracoronary NS administration slowed the conduction velocity of depolarization in the perfusion territory and delayed the timing of J waves to appear. Then, the delayed appearance of J waves would be less opposed by electromotive force from other areas resulting in augmentation. CONCLUSION J wave augmentation was observed during CAG and intracoronary NS administration. As a mechanism of augmentation, we postulated that contrast media and NS induce myocardial ischemia and delay the timing of J waves to a point of less opposition by electromotive force from other areas. HIGHLIGHTS J wave augmentation has been reported during intracoronary injection of contrast media or drugs. The present study confirmed that normal saline alone was able to augment J waves. Mechanistically, coronary interventions using anoxic solutions can cause regional myocardial ischemia and reduce the conduction velocity of depolarization. Then, delayed J waves are less opposed by the electromotive force from remote areas which leads to augmentation. When a drug is diluted in normal saline and given intracoronarily, changes in J waves can be due to normal saline. The pathophysiological and clinical significance of J waves augmented during coronary interventions need to be established.
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Affiliation(s)
- Masafumi Nakayama
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
- Department of Cardiology, Tokyo D Tower Hospital, Tokyo, Japan
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Takao Sato
- Department of Cardiology, Tachikawa General Hospital, Nagaoka, Japan
| | - Masaaki Okabe
- Department of Cardiology, Tachikawa General Hospital, Nagaoka, Japan
| | - Yoshifusa Aizawa
- Research and Development Division, Tachikawa Medical Center, Nagaoka, Japan
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Aizawa Y, Ohashi N, Kawamura A, Ogawa S, Aizawa Y. J wave dynamicity during coronary angiography and intracoronary acetylcholine administration. Pacing Clin Electrophysiol 2023; 46:868-874. [PMID: 37461879 DOI: 10.1111/pace.14787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/27/2023] [Accepted: 07/01/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND J-waves may be observed during coronary angiography (CAG) or intracoronary acetylcholine (ACh) administration, but their significance is unknown. METHODS Forty-nine patients, 59.1 ± 11.5 years old and 59% male, were studied on suspicion of vasospastic angina, and J wave dynamicity was compared between CAG and Ach administration. RESULTS Diagnostic (≥0.1 mV) or nondiagnostic (<0.1 mV) J waves in 9 and 3 patients, respectively, were augmented, and J waves were newly observed in 2 patients during CAG and Ach administration. Similar changes in the J-wave amplitude were observed: from 0.10 ± 0.09 mV to 0.20 ± 0.15 mV (p < .002) and from 0.10 ± 0.10 mV to 0.20 ± 0.16 mV (p < .001) during CAG and Ach administration, respectively. J waves were located in the inferior leads and changed only during the right coronary interventions. In the remaining 35 patients, J waves were absent before and during the coronary interventions. Augmentation of J waves was found when the RR interval was shortened in some patients. Injection of anoxic media into the coronary artery might induce a conduction delay from myocardial ischemia that manifests as augmentation or new occurrence of J waves. CONCLUSIONS Both CAG and intracoronary Ach administration affected J waves similarly in the same individuals. A myocardial ischemia-induced conduction delay may be responsible for the changes in J waves, but further studies are needed.
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Affiliation(s)
- Yoshiyasu Aizawa
- Department of Cardiology, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan
| | - Narutaka Ohashi
- Department of Cardiology, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan
| | - Akio Kawamura
- Department of Cardiology, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan
| | - Satoshi Ogawa
- Department of Cardiology, International University of Health and Welfare Mita Hospital, Minato-ku, Tokyo, Japan
| | - Yoshifusa Aizawa
- Department of Research and Development, Tachikawa Medical Center, Nagaoka, Japan
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Kiriyama H, Kiyosue A, Minatsuki S, Kawahara T, Katsushika S, Kamon T, Hirose K, Shinohara H, Miura M, Saito A, Kikuchi H, Kodera S, Hatano M, Ando J, Myojo M, Itoh N, Yamamoto K, Ikenouchi H, Takeda N, Komuro I. Potential value of saline-induced Pd/Pa ratio in patients with coronary artery stenosis. Front Cardiovasc Med 2023; 9:1001833. [PMID: 36684556 PMCID: PMC9853169 DOI: 10.3389/fcvm.2022.1001833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 12/12/2022] [Indexed: 01/09/2023] Open
Abstract
Background Fractional flow reserve (FFR) is the current gold standard for identifying myocardial ischemia in individuals with coronary artery stenosis. However, FFR is not penetrated as much worldwide due to time consumption, costs associated with adenosine, FFR-related discomfort, and complications. Resting physiological indexes may be widely accepted alternatives to FFR, while the discrepancies with FFR were found in up to 20% of lesions. The saline-induced Pd/Pa ratio (SPR) is a new simplified option for evaluating coronary stenosis. However, the clinical implication of SPR remains unclear. Objectives In the present study, we aimed to compare the accuracies of SPR and resting full-cycle ratio (RFR) and to investigate the incremental value of SPR in clinical practice. Methods In this multicenter prospective study, 112 coronary lesions (105 patients) were evaluated by SPR, RFR, and FFR. Results The overall median age was 71 years, and 84.8% were men. SPR was correlated more strongly with FFR than with RFR (r = 0.874 vs. 0.713, respectively; p < 0.001). Using FFR < 0.80 as the reference standard variable, the area under the receiver-operating characteristic (ROC) curve for SPR was superior to that of RFR (0.932 vs. 0.840, respectively; p = 0.009). Conclusion Saline-induced Pd/Pa ratio predicted FFR more accurately than RFR. SPR could be an alternative method for evaluating coronary artery stenosis and further investigation including elucidation of the mechanism of SPR is needed (225 words).
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Affiliation(s)
- Hiroyuki Kiriyama
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Arihiro Kiyosue
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan,Department of Cardiology, Moriyama Memorial Hospital, Tokyo, Japan
| | - Shun Minatsuki
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan,*Correspondence: Shun Minatsuki,
| | - Takuya Kawahara
- Biostatistics Division, Clinical Research Promotion Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Susumu Katsushika
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Tatsuya Kamon
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Kazutoshi Hirose
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroki Shinohara
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Mizuki Miura
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Akihito Saito
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Hironobu Kikuchi
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Satoshi Kodera
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Masaru Hatano
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Jiro Ando
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Masahiro Myojo
- Department of Cardiology, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Tokyo, Japan
| | - Nobuhiko Itoh
- Department of Cardiology, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Tokyo, Japan
| | - Keisuke Yamamoto
- Department of Cardiology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Hiroshi Ikenouchi
- Department of Cardiology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
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DI Pietro R, Versaci F, Prati F, Burzotta F. Adenosine and fractional flow reserve: no reason to be afraid anymore! Minerva Cardiol Angiol 2020; 69:446-448. [PMID: 33146487 DOI: 10.23736/s2724-5683.20.05501-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Riccardo DI Pietro
- Unit of Hemodynamics, Division of Cardiology, S. Maria Goretti Hospital, Latina, Italy -
| | - Francesco Versaci
- Unit of Hemodynamics, Division of Cardiology, S. Maria Goretti Hospital, Latina, Italy
| | - Francesco Prati
- Department of Cardiovascular Surgery, San Giovanni Addolorata Hospital, Rome, Italy.,Center for Stroke Research Foundation (CLI), Rome, Italy
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