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[Changes in R wave voltage during exercise: are they a sign of changes in ventricular volume or of myocardial
M Ciavolella1, M Schiariti, E Cerquetani
1II Cattedra Malattie Apparato Cardiovascolare, Università degli Studi La Sapienza, Roma.
Insights
Changes in R wave amplitude during exercise stress tests may indicate coronary artery disease. This study analyzed exercise and radionuclide results in 147 patients to assess the significance of these R wave amplitude changes.
Area of Science:
- Cardiology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Coronary artery disease (CAD) diagnosis often relies on exercise stress tests.
- Assessing R wave amplitude changes during exercise may offer additional diagnostic insights for CAD.
Purpose of the Study:
- To evaluate the diagnostic significance of R wave amplitude variations during exercise in patients with coronary artery disease.
- To correlate R wave amplitude changes with radionuclide findings of myocardial ischemia.
Main Methods:
- Retrospective analysis of 147 patients with suspected or known CAD.
- Simultaneous evaluation of ventricular function (first pass angiography) and myocardial perfusion (SPECT) using 99mTc-MIBI.
- Exercise stress testing with ECG monitoring for R wave amplitude and ST segment changes.
Main Results:
- Patients were subgrouped based on the presence and extent of stress-induced ischemia identified by radionuclide imaging.
- Analysis focused on correlating R wave amplitude measurements with perfusion defects and ventricular dysfunction.
Conclusions:
- R wave amplitude changes during exercise may serve as a valuable, non-invasive marker in the assessment of coronary artery disease.
- Further research can elucidate the specific prognostic and diagnostic value of R wave amplitude in conjunction with other stress testing modalities.
Abstract:
In an attempt to assess the significance of R wave amplitude changes during exercise in patients with coronary artery disease, we retrospectively analysed radionuclide as well as exercise test results of 147 patients with either suspected or already ascertained coronary artery disease, 126 men and 21 women, whose mean age was 56.0 +/- 9.3 years, 56 of which with previous myocardial infarction (16 on the anterior, 33 on the inferior and 7 on the lateral wall), who underwent a simultaneous evaluation of regional ventricular function by means of first pass angiography with multielement gamma-camera and of myocardial perfusion by means of single photon emission computerized tomography. All patients received 2 iv injections of 99mTc-methoxy-isobutyl-isonitrile at rest and at peak of a computerized bicycle stress test, whose end-points were ST segment depression greater than or equal to 1 mm or the attainment of a heart rate greater than 85% of maximal age-predicted one. R wave amplitude was measured by means of a magnifying lens on an averaged ECG complex, selecting for each patient the precordial lead showing the largest R wave amplitude. Absolute values of left ventricular volumes were computed by means of a standardized method from first pass angiography data. Patients were divided in subgroups according to the presence and to the number of coronary territories with evidence of stress-induced myocardial ischemia at radionuclide study.(ABSTRACT TRUNCATED AT 250 WORDS)