Salimi M, Hematpour K. Detecting subtle myocardial injury after percutaneous coronary intervention: Insights from electrocardiography and heart rate variability analysis. World J Cardiol 2026; 18(6): 117169 [DOI: 10.4330/wjc.117169]
Corresponding Author of This Article
Khashayar Hematpour, MD, Assistant Professor, Department of Advanced Cardiopulmonary Therapies and Transplantations (ACTAT), University of Texas Health Sciences Center, McGovern Medical School, 6400 Fannin Street, Houston, TX 77030, United States. khashayar.hematpour@gmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Salimi M, Hematpour K. Detecting subtle myocardial injury after percutaneous coronary intervention: Insights from electrocardiography and heart rate variability analysis. World J Cardiol 2026; 18(6): 117169 [DOI: 10.4330/wjc.117169]
World J Cardiol. Jun 26, 2026; 18(6): 117169 Published online Jun 26, 2026. doi: 10.4330/wjc.117169
Detecting subtle myocardial injury after percutaneous coronary intervention: Insights from electrocardiography and heart rate variability analysis
Maryam Salimi, Khashayar Hematpour
Maryam Salimi, Khashayar Hematpour, Department of Advanced Cardiopulmonary Therapies and Transplantations (ACTAT), University of Texas Health Sciences Center, McGovern Medical School, Houston, TX 77030, United States
Author contributions: Salimi M designed the overall outline of the manuscript and drafted it; Hematpour K edited and supervised the manuscript; Salimi M and Hematpour K contributed to this paper, read and approved the final version of the manuscript to be published.
AI contribution statement: During the preparation of this work, the authors used Open-AI’s ChatGPT to improve readability and language. After using this tool, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Corresponding author: Khashayar Hematpour, MD, Assistant Professor, Department of Advanced Cardiopulmonary Therapies and Transplantations (ACTAT), University of Texas Health Sciences Center, McGovern Medical School, 6400 Fannin Street, Houston, TX 77030, United States. khashayar.hematpour@gmail.com
Received: December 2, 2025 Revised: February 2, 2026 Accepted: March 3, 2026 Published online: June 26, 2026 Processing time: 199 Days and 4.8 Hours
Abstract
Percutaneous coronary intervention (PCI) remains one of the most effective therapies for coronary artery disease, yet even technically successful procedures can place short-lived or mild stress on the myocardium. In routine practice, this early myocardial stress often goes unnoticed because standard 12-lead electrocardiography (ECG) and peri-procedural biomarkers are not well suited to detect small, transient, or patchy injury. In a recent observational study by Chaikovsky et al, published in World Journal of Cardiology, explored whether a more detailed ECG-based analysis could uncover these subtle changes. By integrating more than 240 ECG and heart rate variability parameters into composite indices, they identified distinct physiological response patterns in a small cohort of patients undergoing PCI. One subgroup demonstrated post-procedural changes suggestive of mild myocardial injury, including altered ventricular repolarization, increased electrical instability, and reduced autonomic balance – findings that were not captured by conventional ECG interpretation systems. These observations are preliminary and hypothesis-generating, but they highlight the potential of advanced ECG-heart rate variability analytics as a sensitive, noninvasive approach to assessing early myocardial stress after PCI. Larger prospective studies, with correlation to biomarkers, imaging, and clinical outcomes, are needed before such tools can be considered for routine clinical use.
Core Tip: Subtle myocardial stress after percutaneous coronary intervention is common but frequently undetected by routine electrocardiography (ECG) interpretation or selective biomarker testing. A composite ECG-heart rate variability analytical approach has been proposed to capture small electrical and autonomic changes shortly after coronary intervention. Although early and exploratory, this strategy illustrates how more nuanced ECG analysis may complement existing tools and improve post-percutaneous coronary intervention risk assessment once validated.
