Gender aspects on exercise‐induced ECG changes in relation to scintigraphic evidence of myocardial ischaemia

Akil, Shahnaz; Hedén, Bo; Pahlm, Olle; Carlsson, Marcus; Arheden, Håkan; Engblom, Henrik

doi:10.1111/cpf.12483

Cited by 5 publications

(7 citation statements)

References 38 publications

(46 reference statements)

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“…Our findings are of clinical importance because EST is one of the most commonly performed tests in clinical cardiology, and in many parts of the world the predominant test for the assessment of patients with suspected myocardial ischaemia. 2 Our study indicates a similar poor sensitivity and specificity for conventional EST as reported in previous studies 5,6 and demonstrates how the combination of HF-QRS and conventional ST-segment changes as markers of altered de- and repolarization, used in conjunction with all other clinical information, has the potential to improve the currently only modest diagnostic accuracy of EST. The algorithm, used in conjunction with all other available clinical information, could assist in clinical decision making and provide guidance for patients in the ‘rule-in’ and for patients in the ‘rule-out’ group, while patients in the intermediate zone do not directly benefit from the algorithm and certainly need additional testing.…”

Section: Discussionsupporting

confidence: 76%

“…2,4 Although widely recommended and used as the first step in the work-up in intermediate risk patients, 2 the diagnostic accuracy of conventional EST is relatively low and limits its utility. 5,6 Sensitivity of EST lies at 33-50% and specificity at 84-96%. [7][8][9] Imaging modalities provide higher diagnostic accuracy and are increasingly recommended in several guidelines.…”

Section: Introductionmentioning

confidence: 99%

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Incremental value of high-frequency QRS analysis for diagnosis and prognosis in suspected exercise-induced myocardial ischaemia

Schaerli

Abächerli

Walter

et al. 2020

European Heart Journal. Acute Cardiovascular Care

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Aim: Exercise stress testing is used to detect myocardial ischaemia, but is limited by low sensitivity and specificity. The authors investigated the value of the analysis of high-frequency QRS components as a marker of abnormal depolarization in addition to standard ST-deviations as a marker of abnormal repolarization to improve the diagnostic accuracy. Methods and results: Consecutive patients undergoing bicycle exercise stress nuclear myocardial perfusion imaging were prospectively enrolled. Presence of myocardial ischaemia, the primary diagnostic endpoint, was adjudicated using MPI and coronary angiography. Automated high-frequency QRS analysis was performed in a blinded fashion. The prognostic endpoint was major adverse cardiac events (MACEs) during two years of follow-up. Exercise-induced ischaemia was detected in 147/662 patients (22%). The sensitivity of high-frequency QRS was similar to ST-deviations (46% vs. 43%, p=0.59), while the specificity was lower (75% vs. 87%, p<0.001). The combined use of high-frequency QRS and ST-deviations classified 59% of patients as 'rule-out' (both negative), 9% as 'rule-in' (both positive) and 32% in an intermediate zone (one test positive). The sensitivity for 'rule-out' and the specificity for 'rule-in' improved to 63% and 97% compared with ST-deviation analysis alone (both p<0.001). MACE-free survival was 90%, 80% and 42% in patients in the 'rule-out', intermediate and 'rule-in' groups (p<0.001). After adjustment for age, gender, ST-deviations and clinical post-test probability of ischaemia, high-frequency QRS remained an independent predictor for the occurrence of MACEs. Conclusion: The use of high-frequency QRS analysis in addition to ST-deviation analysis improves the diagnostic accuracy during exercise stress testing and adds independent prognostic information.

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Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Incremental value of high-frequency QRS analysis for diagnosis and prognosis in suspected exercise-induced myocardial ischaemia

Schaerli

Abächerli

Walter

et al. 2020

European Heart Journal. Acute Cardiovascular Care

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“…Despite its cost‐effectiveness and noninvasive nature, its clinical utility in this context is progressively declining. Our study reiterates the previously reported inadequate sensitivity and specificity of conventional ST‐segment analysis 3–6 . In contrast, HF‐QRS analysis, which primarily focuses on depolarization abnormalities, manifested superior sensitivity, higher positive likelihood ratio, and lower negative likelihood ratio for CAD detection compared to conventional ST‐segment analysis in our study.…”

Section: Discussionsupporting

confidence: 87%

“…Our study reiterates the previously reported inadequate sensitivity and specificity of conventional ST-segment analysis. [3][4][5][6] In contrast, HF-QRS analysis, which primarily focuses on depolarization abnormalities, manifested superior sensitivity, higher positive likelihood ratio, and lower negative likelihood ratio for CAD detection compared to conventional ST-segment analysis in our study. This aligns with previous reports on the performance of HF-QRS, which used MPI as the gold standard for CAD.…”

Section: Discussioncontrasting

confidence: 59%

“…The currently accepted noninvasive diagnostic examinations for patients suspected of myocardial ischemia include exercise electrocardiogram stress testing (EST), stress echocardiography, stress nuclear myocardial perfusion imaging (MPI), and coronary computed tomography angiography 2 . Nevertheless, research suggested that EST displays a sensitivity range of 33%–50% and specificity between 77% and 89%, thus limiting its clinical efficacy 3–6 . In contrast, imaging techniques exhibit enhanced diagnostic accuracy.…”

Section: Introductionmentioning

confidence: 99%

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The combination of high‐frequency QRS and ST‐segment alterations during exercise stress tests enhanced the diagnostic efficacy for coronary artery disease

Liu,

Du,

Wei

et al. 2024

Clinical Cardiology

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BackgroundHigh‐frequency QRS (HF‐QRS) manifests as a novel adjunct electrocardiographic marker with potential utility in coronary artery disease (CAD) detection.HypothesisWe hypothesize that HF‐QRS analysis may be superior to conventional ST‐segment analysis in detecting CAD, and the combination of these two analyses in the exercise stress test may enhance the diagnostic efficacy for CAD.MethodsThe study incorporated a sample of 157 patients (mean age 62 9 years) referred for nonemergent angiography. Before angiography, patients underwent exercise stress testing utilizing an upright bicycle. High‐resolution electrocardiogram (ECG) data were collected during the exercise test, facilitating both HF‐QRS and conventional ST‐segment analyses. The diagnostic efficacy of HF‐QRS and ST‐segment analysis were compared, utilizing angiographic outcomes as the gold standard. The study design integrated HF‐QRS analysis and ST‐segment analysis via sequential and concurrent testing protocols.ResultsIn terms of CAD detection, HF‐QRS analysis displayed superior sensitivity compared to conventional ST‐segment analysis (63% vs. 37%, p = .002). The serial test significantly increased specificity from 79% to 97% (p = .002) compared to ST‐deviation analysis alone. It showed a markedly low sensitivity of 26%. The parallel test significantly increased sensitivity from 37% to 77% (p < .001), while retaining a moderate level of specificity of 51%. The quantity of ECG leads exhibiting a positive HF‐QRS response demonstrated a correlation with the severity of CAD (p < .001).ConclusionsHF‐QRS analysis exhibited superior sensitivity in detecting angiographically confirmed CAD relative to conventional ST‐segment analysis. Moreover, the combination of HF‐QRS and ST‐segment alterations during exercise stress test enhanced the diagnostic efficacy for CAD.

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Short‐ and long‐term prognostic performance of exercise ECG and myocardial perfusion SPECT

Kraen,

Akil,

Hedén

et al. 2024

Clin Physio Funct Imaging

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BackgroundMyocardial perfusion SPECT (MPS) and exercise electrocardiography (Ex‐ECG) results are of prognostic importance for short‐term follow up duration. However, the value of MPS or Ex‐ECG findings for long‐term risk assessment is less evident as underlying risk factors for ischemic heart disease (IHD) gain in importance.ObjectivesTo assess the short‐ and long‐term prognostic value of MPS and Ex‐ECG in relation to known risk factors.Methods and MaterialsAn observational study of 908 patients (age 63 years, 49% male, 45% prior IHD) referred for MPS and Ex‐ECG. Follow‐up was divided into two periods (short‐term: <5 years and long‐term: >5 years). Cardiac events were defined as a composite of acute myocardial infarction, unstable angina, unplanned revascularization and cardiovascular death.ResultsThe composite endpoint occurred in 95 patients (short‐term follow up) and in 94 patients (long‐term follow up). In multivariable models stress testing had a strong predictive value for short‐term follow up (HR for MPS = 2.9, CI = 1.9–4.5, p < 0.001 and HR for Ex‐ECG = 2.1, CI 1.3–3.3, p = 0.002), but no predictive value for long‐term follow up (HR for MPS = 0.9, CI = 0.5–1.5, p = 0.70 and HR for Ex‐ECG = 1.0, CI = 0.6–1.6, p = 0.92). Male sex and prior IHD were significant predictors regardless of follow up duration. Age, diabetes and decreased exercise capacity were risk factors for long‐term follow up.ConclusionsThe prognostic value of MPS and Ex‐ECG results are strong for short‐term follow up but diminish over time and do not contribute significantly in multivariable models after 5 years. Long‐term prognosis is primarily governed by underlying risk factors and exercise capacity.

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Gender aspects on exercise‐induced ECG changes in relation to scintigraphic evidence of myocardial ischaemia

Cited by 5 publications

References 38 publications

Incremental value of high-frequency QRS analysis for diagnosis and prognosis in suspected exercise-induced myocardial ischaemia

Incremental value of high-frequency QRS analysis for diagnosis and prognosis in suspected exercise-induced myocardial ischaemia

The combination of high‐frequency QRS and ST‐segment alterations during exercise stress tests enhanced the diagnostic efficacy for coronary artery disease

Short‐ and long‐term prognostic performance of exercise ECG and myocardial perfusion SPECT

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