The combination of high-frequency QRS and ST-segment alterations during exercise stress tests enhanced the diagnostic
Long Liu1, Xinyue Du2, Xue Wei1
1The First Clinical College, Chongqing Medical University, Chongqing, China.
Insights
High-frequency QRS (HF-QRS) analysis shows greater sensitivity for detecting coronary artery disease (CAD) than traditional ST-segment analysis. Combining both methods during an exercise stress test significantly improves diagnostic accuracy for CAD.
Area of Science:
- Cardiology
- Medical Diagnostics
- Electrocardiography
Background:
- High-frequency QRS (HF-QRS) is an emerging electrocardiographic marker with potential for detecting coronary artery disease (CAD).
- Conventional ST-segment analysis is a standard method for CAD detection during exercise stress tests.
Purpose of the Study:
- To investigate if HF-QRS analysis is superior to conventional ST-segment analysis in detecting CAD.
- To determine if combining HF-QRS and ST-segment analysis enhances diagnostic efficacy for CAD during exercise stress testing.
Main Methods:
- 157 patients referred for angiography underwent exercise stress testing with high-resolution ECG.
- Both HF-QRS and conventional ST-segment analyses were performed.
- Diagnostic efficacy was compared against angiographic outcomes, using sequential and concurrent testing protocols.
Main Results:
- HF-QRS analysis demonstrated significantly higher sensitivity for CAD detection (63%) compared to ST-segment analysis (37%).
- Serial testing (HF-QRS + ST-segment) increased specificity to 97%, while parallel testing increased sensitivity to 77%.
- The number of ECG leads with a positive HF-QRS response correlated with CAD severity.
Conclusions:
- HF-QRS analysis offers superior sensitivity for detecting angiographically confirmed CAD compared to ST-segment analysis.
- Integrating HF-QRS and ST-segment analysis during exercise stress testing improves the overall diagnostic efficacy for CAD.
Background:
High-frequency QRS (HF-QRS) manifests as a novel adjunct electrocardiographic marker with potential utility in coronary artery disease (CAD) detection.
Hypothesis:
We hypothesize that HF-QRS analysis may be superior to conventional ST-segment analysis in detecting CAD, and the combination of these two analyses in the exercise stress test may enhance the diagnostic efficacy for CAD.
Methods:
The study incorporated a sample of 157 patients (mean age 62 9 years) referred for nonemergent angiography. Before angiography, patients underwent exercise stress testing utilizing an upright bicycle. High-resolution electrocardiogram (ECG) data were collected during the exercise test, facilitating both HF-QRS and conventional ST-segment analyses. The diagnostic efficacy of HF-QRS and ST-segment analysis were compared, utilizing angiographic outcomes as the gold standard. The study design integrated HF-QRS analysis and ST-segment analysis via sequential and concurrent testing protocols.
Results:
In terms of CAD detection, HF-QRS analysis displayed superior sensitivity compared to conventional ST-segment analysis (63% vs. 37%, p = .002). The serial test significantly increased specificity from 79% to 97% (p = .002) compared to ST-deviation analysis alone. It showed a markedly low sensitivity of 26%. The parallel test significantly increased sensitivity from 37% to 77% (p < .001), while retaining a moderate level of specificity of 51%. The quantity of ECG leads exhibiting a positive HF-QRS response demonstrated a correlation with the severity of CAD (p < .001).
Conclusions:
HF-QRS analysis exhibited superior sensitivity in detecting angiographically confirmed CAD relative to conventional ST-segment analysis. Moreover, the combination of HF-QRS and ST-segment alterations during exercise stress test enhanced the diagnostic efficacy for CAD.
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