CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 4, September/October 2023 210 AFRICA As a result, the most crucial arrhythmia mechanism in all MI phases is seen as a re-entry. Therefore, we believe that ECG parameters showing re-entry states such as Tpeak–Tend and Tpeak– Tend/QT interval can be used to predict ventricular arrhythmia in MINOCA patients. Our study has many limitations. First, this was a small, singlecentre study.Themain limitationof our studywas the retrospective cross-sectional design of the study. Another limitation is the visual assessment of coronary angiographic images and the lack of IVUS and OCT for plaque characterisation. Conclusion This study is the first on MINOCA patients to evaluate atrial and ventricular arrhythmia risk in ECG parameters. While no increase was found in the risk of atrial arrhythmia in MINOCA patients, an increase was found in the parameters showing heterogeneity in ventricular repolarisation, which is associated with the risk of ventricular arrhythmia. We believe this study could be helpful for specific recommendations concerning duration of hospitalisation and follow up in MINOCA patients. References 1. Tamis-Holland JE, Jneid H, Reynolds HR, Agewall S, Brilakis ES, Brown TM, et al. Contemporary diagnosis and management of patients with myocardial infarction in the absence of obstructive coronary artery disease: a scientific statement from the American Heart Association. Circulation 2019; 139: e891–e908. 2. Agewall S, Beltrame JF, Reynolds HR, Niessner A, Rosano G, Caforio AL, et al. ESC working group position paper on myocardial infarction with non-obstructive coronary arteries. Eur Heart J 2017; 38: 143–153. 3. Serkan A, Bariş VÖ, Geneş M, Taşkan H, Görmel S, Yildirim E, et al. Myocardial infarction with non-obstructive coronary artery disease, a retrospective cohort study: Are plaque disruption and other pathophysiological mechanisms the same disease? J Surg Med 2021; 5: 50–54. 4. Pelliccia F, Pepine CJ, Berry C, Camici PG. The role of a comprehensive two-step diagnostic evaluation to unravel the pathophysiology of MINOCA: A review. Int J Cardiol 2021; 336: 1–7. 5. Pasupathy S, Air T, Dreyer RP, Tavella R, Beltrame JF. Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries. Circulation 2015; 131: 861–870. 6. Safdar B, Spatz ES, Dreyer RP, Beltrame JF, Lichtman JH, Spertus JA, et al. Presentation, clinical profile, and prognosis of young patients with myocardial infarction with nonobstructive coronary arteries (MINOCA): results from the VIRGO study. J Am Heart Assoc 2018; 7: e009174. 7. Kang WY, Jeong MH, Ahn YK, Kim JH, Chae SC, Kim YJ, et al. Are patients with angiographically near-normal coronary arteries who present as acute myocardial infarction actually safe? Int J Cardiol 2011; 146: 207–212. 8. Skov MW, Ghouse J, Kühl JT, Platonov PG, Graff C, Fuchs A, et al. Risk prediction of atrial fibrillation based on electrocardiographic interatrial block. J Am Heart Assoc 2018; 7: e008247. 9. Bazoukis G, Yeung C, Wui Hang Ho R, Varrias D, Papadatos S, Lee S, et al. Association of QT dispersion with mortality and arrhythmic events – A meta‐analysis of observational studies. J Arrhyth 2020; 36: 105–115. 10. Levin DC, Fallon JT. Significance of the angiographic morphology of localized coronary stenoses: histopathologic correlations. Circulation 1982; 66: 316–320. 11. Chan KH, Ng MK. Is there a role for coronary angiography in the early detection of the vulnerable plaque? Int J Cardiol 2013; 164: 262–266. 12. Alexander B, Milden J, Hazim B, Haseeb S, Bayes‐Genis A, Elosua R, et al. New electrocardiographic score for the prediction of atrial fibrillation: The MVP ECG risk score (morphology‐voltage‐P‐wave duration). Ann Noninvasive Electrocardiol 2019; 24: e12669. 13. Yang N, Yan N, Cong G, Yang Z, Wang M, Jia S. Usefulness of morphology‐voltage‐P‐wave duration (MVP) score as a predictor of atrial fibrillation recurrence after pulmonary vein isolation. Ann Noninvasive Electrocardiol 2020; 25: e12773. 14. Tse G, Gong M, Wong WT, Georgopoulos S, Letsas KP, Vassiliou VS, et al. The Tpeak−Tend interval as an electrocardiographic risk marker of arrhythmic and mortality outcomes: A systematic review and metaanalysis. Heart Rhythm 2017; 14: 1131–1137. 15. Gupta P, Patel C, Patel H, Narayanaswamy S, Malhotra B, Green JT, et al. Tp-e/QT ratio as an index of arrhythmogenesis. J Electrocardiol 2008; 41: 567–574. 16. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, III, Dokainish H, Edvardsen T, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imag 2016; 17: 1321–1360. 17. Kardasz I, De Caterina R. Myocardial infarction with normal coronary arteries: a conundrum with multiple aetiologies and variable prognosis: an update. J Int Med 2007; 261: 330–348. 18. Grodzinsky A, Arnold SV, Gosch K, Spertus JA, Foody JM, Beltrame J, et al. Angina frequency after acute myocardial infarction in patients without obstructive coronary artery disease. Eur Heart J Qual Care Clin Outcomes 2015; 1: 92–99. 19. Bière L, Niro M, Pouliquen H, Gourraud J-B, Prunier F, Furber A, et al. Risk of ventricular arrhythmia in patients with myocardial infarction and non-obstructive coronary arteries and normal ejection fraction. World J Cardiol 2017; 9: 268. 20. Lopez-Pais J, Coronel BI, Gil DG, Pascual MJE, Durán BA, Peredo CGM, et al. Clinical characteristics and prognosis of myocardial infarction with non-obstructive coronary arteries (MINOCA): A prospective single-center study. Cardiol J 2020, Nov 3. Ahead of print. 21. Rasmussen MU, Kumarathurai P, Fabricius‐Bjerre A, Larsen BS, Domínguez H, Davidsen U, et al. P‐wave indices as predictors of atrial fibrillation. Ann Noninvasive Electrocardiol 2020; 25: e12751. 22. Kahyaoglu M, Gecmen C, Candan O, Celik M, Yilmaz Y, Bayam E, et al. The usefulness of morphology‐voltage‐P wave duration ECG score for predicting early left atrial dysfunction in hypertensive patients. Clin Exper Hypertens 2021: 1–7. 23. Hayıroğlu Mİ, Çınar T, Selçuk M, Çinier G, Alexander B, Doğan S, et al. The significance of the morphology-voltage-P-wave duration (MVP) ECG score for prediction of in-hospital and long-term atrial fibrillation in ischemic stroke. J Electrocardiol 2021; 69: 44–50. 24. Tse G, Yan BP. Traditional and novel electrocardiographic conduction and repolarization markers of sudden cardiac death. EP Europace 2017; 19: 712–721. 25. Chugh SS, Reinier K, Singh T, Uy-Evanado A, Socoteanu C, Peters D, et al. Determinants of prolonged QT interval and their contribution to sudden death risk in coronary artery disease: the Oregon Sudden Unexpected Death Study. Circulation 2009; 119: 663–670. 26. Gibbs C, Thalamus J, Kristoffersen DT, Svendsen MV, Holla ØL, Heldal K, et al. QT prolongation predicts short-term mortality independent of comorbidity. EP Europace 2019; 21: 1254–1260.
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