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ST segment analysis by Holter Monitoring: methodological considerations
Preben Bjerregaard1, Amr El-Shafei, Susan L Kotar
1Division of Cardiology, Saint Louis University Health Sciences Center, Saint Louis, MO 63110, USA. bjerregp@slu.edu
Summary
Defining ischemic events using Holter monitoring varies widely, impacting results. A consensus on ST segment analysis criteria is crucial for accurate ischemia detection in clinical trials.
Area of Science:
- Cardiology
- Medical Technology
Background:
- Holter monitoring for ST segment analysis is gaining interest in clinical trials.
- Lack of consensus on defining ischemic events complicates data interpretation.
- A survey revealed inconsistencies in ST segment analysis criteria across publications.
Purpose of the Study:
- To assess the impact of varying ischemic event definitions on Holter monitoring analysis.
- To highlight the need for standardized criteria in ST segment analysis.
Main Methods:
- Applied four different ischemic event criteria to Holter recordings from 66 acute ischemic syndrome patients.
- Utilized lead CM5 and a Reynolds Medical Pathfinder 600 analyzer.
Main Results:
- The most sensitive method (J + 80) identified 24% of patients with ischemic events.
- Requiring J-point depression reduced detection to 15%.
- Correcting for baseline ST depression identified only 4.5% of recordings as positive for ischemia.
Conclusions:
- Holter analysis outcomes for ischemic events are highly dependent on the definition used.
- Urgent need for consensus on defining ischemic events in ST segment analysis.
- Standardized criteria are essential for reliable Holter monitoring interpretation.