Journal of Cardiology & Cardiovascular Surgery scientific, open-access, double-blind peer-reviewed journal covering a wide spectrum of topics in cardiology and cardiovascular surgery. This journal is indexed by indices that are considered international scientific journal indices (DRJI, ESJI, OAJI, etc.). According to the current Associate Professorship criteria, it is within the scope of International Article 1-d. Each article published in this journal corresponds to 5 points.

EndNote Style
Original Article
New electrocardiographic parameters and risk of atrial arrhythmias in INOCA patients
Aims: Ischemia with no obstructive arteries (INOCA) is a clinical condition in which symptoms and signs of coronary artery disease are present, but coronary angiography does not show severe vessel narrowing. Atrial fibrillation (AF) is a common arrhythmia in cardiology practice, with an increasing prevalence with age and concomitant heart disease. P-wave dispersion (PWD) is an electrocardiographic (ECG) parameter defined as the difference between the maximum and minimum P-wave duration. There is an increasing number of studies showing an association between PWD and cardiovascular events. In this study, we aimed to evaluate the risk of AF in INOCA patients by detecting PWD, a new ECG parameter.
Methods: The study included 51 INOCA patients and 36 healthy subjects as a control group. The groups were compared in terms of demographic characteristics, laboratory findings, echocardiography, and ECG findings. The difference between the longest P wave (Pmax) and the shortest P wave (Pmin) was considered as PWD (PWD=Pmax-Pmin).
Results: When the patient group was compared with the control group, no difference was detected in terms of demographic characteristics or laboratory findings. When compared with the control group, Pmax duration and Pd values were significantly longer in the patient group compared to the control group (Pmax durations 112.7±7.09 ms and 98.1±5.5 ms, respectively, p<0.001; Pd durations 43.0±9.4 ms and 31.4±12.4 ms, respectively, p<0.001). On the other hand, Pmin durations did not differ significantly between the groups (p>0.05).
Conclusion: We observed that PWD was higher in INOCA patients compared to controls, and our results suggest that INOCA patients are at risk for AF.

1. Gulati M, Levy PD, Mukherjee D, et al. AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis ofchest pain: executive summary: a report of the American college ofcardiology/American heart association joint committee on clinicalpractice guidelines. Circulation. 2021;144(22):e368-454.
2. Hansen B, Holtzman JN, Juszczynski C, et al. Ischemia with NoObstructive Arteries (INOCA): A Review of the Prevalence, Diagnosisand Management. Curr Probl Cardiol. 2023;48(1):101420.
3. Bastiany A, Pacheco C, Sedlak T, et al. A Practical Approach to InvasiveTesting in Ischemia With No Obstructive Coronary Arteries (INOCA).CJC Open. 2022;4(8):709-720.
4. Ruff CT, Giugliano RP, Braunwald E, et al. Comparison of the efficacyand safety of new oral anticoagulants with warfarin in patients withatrial fibrillation: a meta-analysis of randomised trials. Lancet (London,England). 2014;383:955-962.
5. Saglietto A, Varbella V, Ballatore A, Xhakupi H, Ferrari GM, AnselminoM. Prognostic implications of atrial fibrillation in patients with stablecoronary artery disease: a systematic review and meta-analysis ofadjusted observational studies. Rev Cardiovasc Med. 2021;22(2):439-444.
6. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guidelinefor the management of patients with atrial fibrillation: a report of theAmerican College of Cardiology/American Heart Association TaskForce on Practice Guidelines and the Heart Rhythm Society. J Am CollCardiol. 2014;64(21):e1-e76.
7. Miller JD, Aronis KN, Chrispin J, et al. Obesity, exercise, obstructivesleep apnea, and modifiable atherosclerotic cardiovascular disease riskfactors in atrial fibrillation. J Am Coll Cardiol. 2015;66(25):2899-2906.
8. Boos CJ, Anderson RA, Lip GY. Is atrial fibrillation an inflammatorydisorder? Eur Heart J. 2006;27:136-149.
9. Issac TT, Dokainish H, Lakkis NM. Role of inflammation in initiationand perpetuation of atrial fibrillation: A systematic review of thepublished data. J Am Coll Cardiol. 2007;50:2021-2028.
10. Ozaydin M, Peker O, Erdogan D, et al. Oxidative status, inflammation,and postoperative atrial fibrillation with metoprolol vs carvedilolor carvedilol plus N-acetyl cysteine treatment. Clin Cardiol.2014;37(5):300-306.
11. Thompson AE, Hirsch GM, Pearson GJ. Assessment of new onsetpostcoronary artery bypass surgery atrial fibrillation: current practicepattern review and the development of treatment guidelines. J ClinPharm Ther. 2002;27(1):21-37.
12. Magnani JW, Mazzini MJ, Sullivan LM, Williamson M, EllinorPT, Benjamin EJ. P-wave indices, distribution and quality controlassessment (from the Framingham Heart Study). Ann NoninvasiveElectrocardiol. 2010;15(1):77-84.
13. Liu Z, Hayano M, Hirata T, et al. [Abnormalities of electrocardiographicP wave morphology and the relationship to electrophysiologicalparameters of the atrium in patients with idiopathic paroxysmal atrialfibrillation]. J Cardiol. 1998;32(3):189-196.
14. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiacchamber quantification by echocardiography in adults: an updatefrom the American Society of Echocardiography and the EuropeanAssociation of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28: 1-39.e14.
15. Gulati M, Cooper-DeHoff RM, McClure C, et al. Adverse cardiovascularoutcomes in women with nonobstructive coronary artery disease: areport from the Women&rsquo;s Ischemia Syndrome Evaluation Study andthe St James Women Take Heart Project. Arch Intern Med 2009;169(9):843-850.
16. Schumann CL, Mathew RC, Dean JL, et al. Functional and EconomicImpact of INOCA and Influence of Coronary MicrovascularDysfunction. JACC Cardiovasc Imaging 2021;14(7):1369-1379.
17. Dilaveris PE, Gialafos EJ, Sideris SK, et al. Simple electrocardiographicmarkers for the prediction of paroxysmal idiopathic atrial fibrillation.Am Heart J. 1998;135:733-738.
18. Dilaveris PE, Gialafos EJ, Andrikopoulos GK, et al. Clinical andelectrocardiographic predictors of recurrent atrial fibrillation. PacingClin Electrophysiol. 2000; 23: 352-358.
19. Aytemir K, Ozer N, Atalar E, et al. P wave dispersion on 12-leadelectrocardiography in patients with paroxysmal atrial fibrillation.Pacing Clin Electrophysiol. 2000;23:1109-1112.
20. Ozuğuz U, Erg&uuml;n G, Işık S, et al. Association between C-reactiveprotein, carotid intimamedia thickness and P-wave dispersion in obesepremenopausal women: an observational study. Anadolu Kardiyol Derg.2012;12:40-46.
21. Turkmen M, Barutcu I, Esen AM, Karakaya O, Esen O, BasaranY. Effect of slow coronary flow on P-wave duration and dispersion.Angiology 2007;58:408-412.
22. Gunduz H, Binak E, Arinc H, et al. The relationship between P wavedispersion and diastolic dysfunction. Tex Heart Inst J. 2005;32:163-167.
23. Tukek T, Akkaya V, Atilgan D, et al. Effect of left atrial size andfunction on P-wave dispersion:A study in patients with paroxysmalatrial fibrillation. Clin Cardiol 2001;24, 676-680.
24. Dilaveris PE, Gialafos EJ, Chrissos D, et al. Detection of hypertensivepatients at risk for paroxysmal atrial fibrillation during sinus rhythmby computer assisted P wave analysis. J Hypertens 1999;17:1463-1470.
25. Hashemi Jazi M, Amirpour A, Zavvar R, Behjati M, Gharipour M:Predictive value of P wave duration and dispersion in post Coronaryartery bypass surgery atrial fibrillation. ARYA Atherosclerosis. 2012;8:59-62.
26. Altun A, Erdogan O, Tatli E, Ugur-Altun B, Durmus-Altun G, Ozbay G.Increased P wave dispersion: a new finding in patients with syndromeX. Can J Cardiol. 2002;18:1207-1210.
27. Ariyarajah V, Malinski M, Khadem A, Harizi R, Wolfe K, SpodickDH. Relation of recurrence of atrial fibrillation after nonST-elevationacute myocardial infarction to left atrial abnormality. Am J Cardiol.2008;101:30-34.
28. Eggers KM, Hjort M, Baron T, et al. Morbidity and cause-specificmortality in first-time myocardial infarction with nonobstructivecoronary arteries. J Intern Med. 2019;285(4):419-428.
29. Gorenek B, Kudaiberdieva G. Atrial fibrillation in acute ST-elevationmyocardial infarction: clinical and prognostic features. Curr CardiolRev. 2012;8(4):281-289.
30. El-Shetry M, Mahfouz R, Frere AF, Abdeldayem M. The interplaybetween atrial fibrillation and acute myocardial infarction. Br J HospMed (Lond). 2021;82(2):1-9.
31. Jons C, Joergensen RM, Hassager C, et al. Diastolic dysfunction predictsnew-onset atrial fibrillation and cardiovascular events in patients withacute myocardial infarction and depressed left ventricular systolicfunction: a CARISMA substudy. Eur J Echocardiogr. 2010; 11: 602-607.
32. Aronson D, Mutlak D, Bahouth F, et al. Restrictive left ventricularfilling pattern and risk of new-onset atrial fibrillation after acutemyocardial infarction. Am J Cardiol. 2011;107:1738-1743.
33. Yilmaz R, Kasap H, Baykan M, et al. Assessment of left ventricularfunction by Doppler tissue imaging in patients with atrial fibrillationfollowing acute myocardial infarction. Int J Cardiol. 2005;102:79-85.
34. Rodrigues AB, Gismondi RA, Lagoeiro A, et al. Association betweenB-type natriuretic peptide and within-visit blood pressure variability.Clin Cardiol. 2018;41(6):778-781.
35. Hwang HJ, Ha JW, Joung B, et al. Relation of inflammation and leftatrial remodeling in atrial fibrillation occurring in early phase of acutemyocardial infarction. Int J Cardiol. 2011;146:28-31.
36. Aronson D, Boulos M, Suleiman A, et al. Relation of C-reactive proteinand new-onset atrial fibrillation in patients with acute myocardialinfarction. Am J Cardiol 2007;100:753-757.
37. Yilmaz Y, Kelesoglu S, Elcik D, Ozmen R, Kalay N. Predictive Valuesof Systemic Immune-Inflammation Index in New-Onset AtrialFibrillation Following Coronary Artery Bypass Grafting. Braz JCardiovasc Surg. 2023;38(1):96-103.
38. Ulus T, Isgandarov K, Yilmaz AS, Vasi I, Moghanchızadeh SH, Mutlu F.Predictors of new-onset atrial fibrillation in elderly patients with acutecoronary syndrome undergoing percutaneous coronary intervention.Aging Clin Exp Res. 2018;30(12):1475-1482
39. Liu L, Gan S, Li B, Ge X, Yu H, Zhou H. Fisetin Alleviates AtrialInflammation, Remodeling, and Vulnerability to Atrial Fibrillationafter Myocardial Infarction. Int Heart J. 2019;60(6):1398-1406.
40. Chang CM, Wu TJ, Zhou S, et al. Nerve sprouting and sympathetichyperinnervation in a canine model of atrial fibrillation produced byprolonged right atrial pacing. Circulation. 2001;103:22-25.
41. Jayachandran JV, Sih HJ, Winkle W, Zipes DP, Hutchins GD, OlginJE. Atrial fibrillation produced by prolonged rapid atrial pacingis associated with heterogeneous changes in atrial sympatheticinnervation. Circulation. 2000;101:1185-1191.
Volume 1, Issue 4, 2023
Page : 86-89