Improved detection of ischemic heart disease by combining high-frequency electrocardiogram analysis with exercise
Jin-Oh Choi1, Sung-A Chang, Sung Ji Park
1Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Insights
High-frequency QRS (HFQRS) analysis during exercise stress echocardiography (ESE) shows promise for detecting coronary artery disease (CAD). This method offers improved diagnostic accuracy compared to traditional ST-segment analysis in identifying significant CAD.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Techniques
Background:
- Traditional exercise treadmill tests (ETT) using ST-segment analysis have limitations in sensitivity and specificity for detecting coronary artery disease (CAD).
- High-frequency components of the QRS complex (HFQRS) offer potential for improved CAD detection.
Purpose of the Study:
- To evaluate the feasibility of analyzing HFQRS during exercise stress echocardiography (ESE).
- To assess the clinical usefulness of HFQRS analysis in detecting significant CAD.
Main Methods:
- 175 patients undergoing ESE were analyzed, with confirmation of coronary artery disease (CAD) via computed tomographic or coronary angiography.
- Exercise treadmill testing incorporated both conventional ST-segment analysis and HFQRS intensity analysis.
Main Results:
- HFQRS analysis demonstrated a sensitivity of 68.8% and specificity of 74.8% for significant CAD.
- A combined model of HFQRS analysis and ESE achieved the highest diagnostic accuracy (AUC 0.948), significantly outperforming ST-segment analysis (AUC 0.679).
Conclusions:
- HFQRS analysis is feasible during ESE.
- This technique may provide valuable additional information for diagnosing significant CAD.
Background And Objectives:
Because the exercise treadmill test (ETT) based on ST-segment analysis is limited due to low sensitivity and specificity, there has been an interest in the additional analysis of high-frequency components of QRS (HFQRS) for the detection of coronary artery disease (CAD). We sought to evaluate the feasibility and clinical usefulness of HFQRS analysis during exercise stress echocardiography (ESE).
Subjects And Methods:
We evaluated 175 patients (age 57±9,118 men) who performed ESE and either coronary computed tomographic angiography or coronary angiography. ETT was performed using the HyperQ stress system for both conventional ST-segment analysis and HFQRS intensity analysis.
Results:
Thirty-two patients (31%) had significant CAD. The sensitivity and specificity of HFQRS analysis were 68.8% and 74.8%, respectively. The combined model, including HFQRS analysis and ESE, provided the best diagnostic accuracy, with the area under the receiver-operating characteristics curve (AUC) of 0.948 {95% confidence interval (CI)=0.913-0.984} compared with ST-segment analysis (AUC 0.679, 95% CI=0.592-0.766).
Conclusion:
HFQRS analysis during ESE is feasible and may provide additional diagnostic information for the detection of significant CAD.
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