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Transient ST segment depression during Holter monitoring: how to avoid false positive findings
H Völler1, D Andresen, T Brüggemann
1Department of Cardiopulmonology, Klinikum Steglitz, Freien Universität Berlin, Germany.
Insights
Adding detailed shape analysis to 24-hour Holter monitoring significantly improves the detection of transient myocardial ischemia. This method helps differentiate genuine ST deviations from artifacts, increasing diagnostic specificity for silent ischemia.
Area of Science:
- Cardiology
- Medical Diagnostics
Background:
- 24-hour Holter monitoring is crucial for detecting transient myocardial ischemia.
- Distinguishing genuine ST deviations from artifacts is essential for accurate diagnosis.
Purpose of the Study:
- To enhance the specificity of 24-hour Holter monitoring for transient myocardial ischemia.
- To evaluate the utility of ST segment shape analysis in differentiating true ischemia from artifacts.
Main Methods:
- Screened 85 healthy subjects using 24-hour Holter monitoring.
- Assessed ST segment depression based on extent, frequency, and duration.
- Applied supplementary shape analysis criteria to identify artifact-induced ST changes.
Main Results:
- Six subjects (7.1%) exhibited ST segment depression meeting standard criteria.
- Shape analysis successfully identified artifacts in four volunteers.
- Only two subjects (2.4%) showed ambiguous results, indicating high specificity.
Conclusions:
- Standard Holter monitoring criteria (extent, frequency, duration) are insufficient for differentiating true silent ischemia from false positives.
- Supplementary ST segment shape analysis significantly increases the specificity of 24-hour Holter monitoring for detecting transient myocardial ischemia.
Abstract:
To increase the specificity of 24-hour Holter monitoring in detecting transient myocardial ischemia, we separated genuine ST deviations from those dependent on artifacts by adding a detailed shape analysis of real-time printouts to the usual criteria of significant ST segment depression. We screened 116 apparently healthy subjects; 31 had to be excluded, because of pathologic findings in preliminary examinations. The remaining 85 (49 women and 36 men; mean age, 43.1 years) underwent Holter monitoring for assessment of the extent, frequency, and duration of episodes of horizontal and descending ST segment depression of at least 0.1 mV that persisted for at least 60 msec after the J point and that were at least 1 minute apart. On the basis of these criteria, six subjects (7.1%) showed 24 episodes of horizontal or descending ST segment depression with a mean of 0.2 mV (range, 0.15 to 0.25 mV), a frequency of four episodes per 24 hours (one to nine), and a duration of 12.2 minutes (range 3-range 41 minutes). Supplementary criteria--e.g., sudden onset of ST segment depression, identical orientation of PQ and ST segments, or simultaneous increase in R and P wave amplitude--made it possible to identify ST changes caused by artifacts in four volunteers. In only two subjects (2.4%) could true silent ischemia not be differentiated from false positive results. Thus consideration of only the extent, frequency, and duration of episodes does not permit a differentiation between true silent ischemia and false positive results. A supplementary shape analysis increases the specificity of ST segment analysis in detecting transient myocardial ischemia during 24-hour Holter monitoring.