QRS prolongation on the signal‐averaged electrocardiogram versus st‐segment changes on the 12‐lead electrocardiogram: Which is the most sensitive electrocardiographic marker of myocardial ischemia?

Michaelides, Andreas; Dilaveris, Polychronis; Psomadaki, Zoi D.; Richter, D; Andrikopoulos, George; Pitsilides, Nikolaos; Stefanadis, Christodoulos; Toutouzas, Pavlos; Dounis, Vasilios

doi:10.1002/clc.4960220607

Cited by 12 publications

(3 citation statements)

References 33 publications

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“…13,14 Several studies have demonstrated that the specificity of QRS prolongation for the detection of myocardial ischemia is similar to that of ST-segment changes, whereas the sensitivity of the former is higher. [10][11][12] In the present study, QRS prolongation and ST-segment elevation in lead aVR had similar specificity, but the former was more sensitive, for predicting LM/3VD. The second possible reason for the strong association between QRS duration and LM/3VD is that QRS prolongation might correlate with heart failure.…”

Section: Discussionsupporting

confidence: 61%

“…Although electrocardiographic assessment of myocardial ischemia is usually based on ST-segment deviation, QRS prolongation has been shown to be more sensitive than ST-segment changes for the detection of myocardial ischemia. [10][11][12] Several studies have found that that exercise-induced QRS prolongation is related to the severity and extent of coronary artery disease. 13,14 However, the relationship between QRS duration on the admission electrocardiogram (ECG) and the severity and extent of coronary artery disease has not been explored previously in patients with NSTE-ACS.…”

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confidence: 99%

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Early, Accurate, Non-Invasive Predictors of Left Main or 3-Vessel Disease in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome

Kosuge

Ebina

Hibi

et al. 2009

Circ J

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Background:In patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS), identification of left main and/or 3-vessel disease (LM/3VD) is crucial for deciding whether to initiate early treatment with clopidogrel, which can increase the risk of surgical bleeding. Methods and Results: On admission, the clinical factors of 501 patients with NSTE-ACS, who underwent coronary angiography, were evaluated. ST-segment shifts and the widest QRS duration were measured on an admission 12-lead electrocardiogram. Ninety-six patients had LM/3VD. Univariate analysis indicated that many factors were related to LM/3VD. On multivariate analysis, QRS duration (odds ratio (OR) 9.04, P<0.01), the degree of ST-segment elevation in lead aVR (OR 7.10, P<0.01), and positive-troponin T (OR 1.52, P<0.05) were independent predictors of LM/3VD. A QRS duration of >90 ms and a ST-segment elevation in lead aVR of ≥0.5 mm best identified LM/3VD. A QRS duration of >90 ms, a ST-segment elevation in lead aVR of ≥0.5 mm, and a positive-troponin T identified LM/3VD with sensitivities of 88%, 76%, and 54% (P<0.01), and specificities of 88%, 86%, and 71% (P<0.01), respectively. Conclusions: A prolonged QRS duration, ST-segment elevation in lead aVR, and a positive-troponin T on admission are useful predictors of LM/3VD in patients with NSTE-ACS. In particular, a maximal QRS duration of >90 ms was the most sensitive predictor of LM/3VD. (Circ J 2009; 73: 1105 -1110

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Section: Discussionsupporting

confidence: 61%

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confidence: 99%

Early, Accurate, Non-Invasive Predictors of Left Main or 3-Vessel Disease in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome

Kosuge

Ebina

Hibi

et al. 2009

Circ J

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“…Different results were reported in the past human studies on the transient myocardial ischemia detection using SAECG. Michaelides et al 24 reported that the duration of QRS was significantly prolonged in SAECG at the time of spontaneous attack of angina pectoris, and suggested that it could be used as a more sensitive marker for detection of myocardial ischemia in comparison with in ST-segment change of standard ECG. Rubin et al reported that a transient late potential and prolonged QRS of SAECG occurred during the balloon inflation in percutaneous transluminal coronary angioplasty.…”

Section: Evaluation Of Dipyridamole Stress Saecg For Cad Vs Controlmentioning

confidence: 99%

Portable Type Signal-Averaged Electrocardiography With Dipyridamole A New and Convenient Method to Detect Patients With Coronary Artery Disease and Ischemia

Matsumoto

Hiraki

Yoshida

et al. 2005

Circ J

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xercise electrocardiography is frequently used as a diagnostic test for coronary artery disease (CAD). This method takes an advantage of changes in STsegment of a standard electrocardiography (ECG) at the time of myocardial ischemia. It is a non-invasive and relatively simple method, but there are some problems. Because a special device is required, the method cannot be used at the bedside. Nor is it applicable to patients who have orthopedic problems.Previous studies in experimental animals have shown that acute myocardial ischemia results in a decreased conduction velocity of the myocardium. This decreased conduction velocity during myocardial ischemia is manifested as QRS prolongation in the surface ECG. [1][2][3][4][5] Holland and Brooks produced ischemia in the anterior wall of the myocardium after acute ligation of the left anterior descending coronary artery in pigs and demonstrated QRS prolongation. 1 Similar findings were observed in other experimental studies. [2][3][4][5] These reports have demonstrated that extracellular K + at the ischemic area is increased in association with decreased conduction velocity. It is postulated that Circulation Journal Vol.69, June 2005 this regional hyperkalemia delays conduction velocity.Prolonged QRS duration in the standard 12-lead ECG during exercise was demonstrated in CAD patients. [6][7][8][9][10] However, it is difficult to detect subtle changes in the prolongation of QRS interval using the standard 12-lead ECG. The subtle changes in QRS duration can be evaluated using the filtered QRS wave duration (fQRSd) on the signal-averaged ECG (SAECG). 11-15 However, a conventional SAECG recording device is fixed in order to cope with the problem of noise, and the recording is limited to an electrically shielded room. It is difficult to perform a stress test to induce myocardial ischemia of patients with CAD in an electrically shielded room. A portable type SAECG (portable SAECG) maintains a sufficiently low noise level for recording outside the electrically shielded room. As in the case of a standard ECG recording, bedside recording is easily performed and stress inducement is possible.Using this portable SAECG recording device, we investigated whether or not patients with CAD could be easily detected at the bedside using dipyridamole stress. Methods Study PatientsThe study population consisted of 80 patients who had chest pain as their chief complaint and who were hospitalized in the Third Department of Internal Medicine of Kurume University between January 1999 and February Background Whether or not patients with coronary artery disease (CAD) could be easily detected at the bedside using dipyridamole stress was investigated using a portable type signal-averaged electrocardiography (portable SAECG). Methods and ResultsThe standard 12-lead QRS wave SAECG was performed at the bedside before and after dipyridamole stress in 30 patients with angiographically significant stenotic lesions, who had positive myocardial ischemia in the dipyridamole-thallium myocardial perfus...

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A new screening method to diagnose coronary artery disease using multichannel magnetocardiogram and simple exercise

Kanzaki¹,

Nakatani²,

Kandori

et al. 2003

Basic Research in Cardiology

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QRS prolongation on the signal‐averaged electrocardiogram versus st‐segment changes on the 12‐lead electrocardiogram: Which is the most sensitive electrocardiographic marker of myocardial ischemia?

Cited by 12 publications

References 33 publications

Early, Accurate, Non-Invasive Predictors of Left Main or 3-Vessel Disease in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome

Early, Accurate, Non-Invasive Predictors of Left Main or 3-Vessel Disease in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome

Portable Type Signal-Averaged Electrocardiography With Dipyridamole A New and Convenient Method to Detect Patients With Coronary Artery Disease and Ischemia

A new screening method to diagnose coronary artery disease using multichannel magnetocardiogram and simple exercise

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