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[The diagnostic value of resting electrocardiography in stable coronary artery disease]
M Lewandowski1, H Szwed, I Kowalik
1Klinika Choroby Wieńcowej Instytutu Kardiologii w Warszawie.
Insights
Resting electrocardiograms (ECG) show limited sensitivity for detecting coronary artery disease in stable angina patients. A normal ECG does not rule out significant blockages, highlighting the need for further diagnostic tests.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Clinical Electrocardiography
Background:
- Stable angina pectoris is a common condition requiring accurate diagnosis.
- Coronary artery disease (CAD) assessment often involves invasive procedures like coronary angiography.
- Resting electrocardiography (ECG) is a non-invasive tool used in initial patient evaluation.
Purpose of the Study:
- To evaluate the relationship between resting electrocardiographic (ECG) patterns and angiographic findings in patients with stable angina.
- To determine the diagnostic accuracy of resting ECG for identifying coronary artery disease (CAD).
Main Methods:
- 566 patients with stable angina underwent diagnostic coronary angiography and 12-lead resting ECG.
- ECG interpretations were categorized as normal, nonspecific abnormalities, or typical for coronary insufficiency.
- Coronary artery disease was defined as >= 70% stenosis in major vessels or >= 50% in the left main coronary artery.
Main Results:
- A typical ECG pattern for coronary insufficiency was found in 18% of patients.
- The sensitivity and specificity of a typical ECG for CAD were 23% and 87% overall.
- Notably, 49% of patients had a normal resting ECG, yet 55% of these had significant coronary artery stenosis.
Conclusions:
- Resting ECG has low sensitivity for detecting significant coronary artery disease in stable angina patients.
- A normal resting ECG does not exclude the presence of clinically important coronary artery disease.
- Further diagnostic investigations are crucial for patients with suspected CAD, even with a normal resting ECG.
Abstract:
The relation of resting electrocardiographic (ECG) patterns to angiographic features was assessed in 566 patients with chest pain regarded as definite or probable stable angina pectoris. The indications for catheterization in each patient were determined at the discretion of the attending physician. All patients underwent diagnostic coronary angiography (clinically important coronary artery disease was defined as > or = 70 per cent narrowing of the diameter of at least one major vessel or > or = 50 per cent of the left main coronary artery) and standard 12 lead electrocardiography which was interpreted by 2 cardiologists independently in coordinating centre. The signs of impaired coronary blood flow were assessed by abnormalities of repolarization (among others S-T segment, the T wave), depolarization and presence of disturbances of cardiac rythm. The resting routine electrocardiogram was assigned to one of three categories: normal, nonspecific abnormalities or typical for coronary insufficiency. The typical pattern for ischemia was present in 104 patients (18%), nonspecific abnormalities were present in 185 patients (33%) and electrocardiogram was normal in 277 patients (49%). Sensitivity and specificity of the typical for coronary insufficiency resting ECG was calculated: 23% and 87% respectively for the entire group, 33% and 81% in women, 20% and 93% in men. In the group with normal resting electrocardiographic pattern 55% of patients have significant stenosis in at least one major coronary artery.