Related Experiment Videos
[Validation of the Holter method in detecting myocardial ischemia using an exercise test simultaneously]
I Rayo1, E Marín Huerta, A Muela
1Servicio de Cardiología, Hospital Ramón y Cajal, Madrid.
Insights
Holter monitoring reliably detects myocardial ischemic changes during exercise tests. A two-channel system with specific leads demonstrated high accuracy in reproducing ST-segment changes, confirming its clinical utility.
Area of Science:
- Cardiology
- Diagnostic Electrocardiography
Background:
- Myocardial ischemia detection is crucial for cardiovascular health.
- Holter monitoring is a common tool, but its reliability in reproducing exercise-induced ischemic changes requires evaluation.
Purpose of the Study:
- To assess the accuracy of a two-channel Holter monitoring system in detecting ST-segment changes during treadmill exercise tests.
- To compare Holter monitoring results with a conventional 12-lead electrocardiogram.
Main Methods:
- 110 patients underwent a Bruce protocol treadmill exercise test.
- Simultaneous electrocardiogram recordings using a two-channel Holter (CM-V3, CM-V5 leads) and a 12-lead system.
- Ischemic ST-segment change defined as ≥1 mm depression >0.08 sec post-J point.
Main Results:
- High concordance between Holter and 12-lead ECG in 101 patients.
- Overall accuracy: 81.8% sensitivity, 98.5% specificity, 97.3% PPV, 89.0% NPV.
- Strong correlations found for ST-segment depression, duration of ischemia, and heart rates.
Conclusions:
- Two-channel Holter recording with CM-V3 and CM-V5 leads reliably reproduces ST-segment changes indicative of myocardial ischemia.
- This system demonstrates significant accuracy and clinical utility for diagnosing exercise-induced ischemia.
Unlabelled:
To evaluate the reliability of Holter monitoring in reproducing myocardial ischemic changes, 110 patients (90 males, 20 females; age range: 14-74 years) underwent a Bruce protocol treadmill exercise test. An electrocardiogram was recorded simultaneously with a two-channel modulated Holter recorder (frequency response: 0.05-100 Hz) with bipolar CM-V3 and CM-V5 leads and by a conventional 12-lead system. An ischemic ST-segment change was defined as 1 mm or more ST-segment depression lasting more than 0.08 sec after the J point. Results were concordant in 101 patients, 36 with both positive and 65 with both negative responses. Eight false negative and one false positive Holter ischemic episodes occurred. This yielded an accuracy (expressed as sensitivity, specificity, positive and negative predictive values) of 81.8%, 98.5%, 97.3% and 89.0%, respectively. There was a good correlation between the maximal ST-segment depression (r = 0.57; p less than 0.001), duration of ischemia (r = 0.89; p less than 0.001), heart rate at the onset of the ischemic episode (r = 0.91; p less than 0.001) and maximal heart rate (r = 0.98; p less than 0.001).
Conclusions:
Two-channel amplitude modulated Holter recording system with bipolar CM-V3 and CM-V5 leads can reliably reproduce ST-segment changes.