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Comparison of ST depression recorded by Holter monitors and 12-lead ECGs during coronary angiography and exercise
Insights
Holter monitors show low sensitivity for detecting myocardial ischemia, often underestimating ST depression compared to the standard 12-lead electrocardiogram (ECG). Automated analysis programs also yielded unreliable results, questioning Holter ECGs
Area of Science:
- Cardiology
- Medical Devices
- Diagnostic Tools
Background:
- The reliability of Holter monitors as indicators of myocardial ischemia is debated, with the 12-lead electrocardiogram (ECG) being the established standard.
- Previous studies present conflicting data on the efficacy of Holter monitoring for diagnosing ischemic events.
Purpose of the Study:
- To directly compare ST depression recorded by simultaneous 12-lead ECG and Holter monitoring in patients with typical angina pectoris.
- To evaluate the accuracy of automated ST analysis programs using Holter recordings against the 12-lead ECG standard.
Main Methods:
- Simultaneous 12-lead ECG and Holter recordings were obtained from 30 patients experiencing typical angina pectoris.
- Recordings were conducted during coronary angiography or exercise testing.
- ST depression events were compared between Holter and 12-lead ECGs, with the latter serving as the reference standard. Automated analysis of Holter tapes was also performed.
Main Results:
- Only 37.1% of 12-lead ECG-identified ST depression events were detected by Holter recordings.
- Holter recordings significantly underestimated the degree of ST depression compared to 12-lead ECGs (p < 0.0001).
- Automated analysis showed high false positive rates (67.0% for one program) and overestimation of ST depression (second program, p = 0.0033).
Conclusions:
- Holter-detected ST depression is not a reliable electrocardiographic indicator of myocardial ischemia.
- Current automated analysis tools for Holter ECGs demonstrate significant limitations in accuracy.
- The 12-lead ECG remains the superior standard for assessing myocardial ischemia.
Abstract:
Data from previous studies are debatable regarding whether Holter monitors are a reliable electrocardiographic indicator of ischemia, for which the 12-lead electrocardiogram (ECG) is the standard. Simultaneous 12-lead and Holter ECGs were performed on 30 patients with typical angina pectoris during coronary angiography or exercise testing. ST depression recorded by both methods was directly compared, using the 12-lead ECG as the reference. The Holter tapes were also scanned by two automated ST analysis programs and the results were compared to 12-lead ECGs. Only 66 of the 178 12-lead ECG ST depression events were also present on the Holter recordings (37.1% Holter sensitivity). ST depression was underestimated by the Holter recordings compared to the 12-lead ECGs (p < 0.0001). The majority (67.0%) of ST depression events identified by one computer program were false positive events. The degree of ST depression was overestimated compared to 12-lead ECGs by the second program (p = 0.0033). Holter-detected ST depression may not be a reliable ECG indicator of myocardial ischemia.