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Related Experiment Videos

Holter recording during treadmill testing in assessing myocardial ischemic changes.

D Tzivoni, J Benhorin, A Gavish

    The American Journal of Cardiology
    |April 15, 1985
    PubMed
    Summary

    A 2-channel Holter monitor accurately detects exercise-induced ischemic changes, comparable to a 12-lead ECG. This ambulatory monitoring system reliably reproduces ST segment changes during treadmill tests.

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    Area of Science:

    • Cardiology
    • Exercise Physiology
    • Diagnostic Electrocardiography

    Background:

    • Exercise electrocardiography is crucial for diagnosing ischemic heart disease.
    • Conventional 12-lead ECGs during exercise can be limited by lead placement and recording duration.
    • Ambulatory Holter monitoring offers continuous ECG recording but its utility during exercise stress testing requires validation.

    Purpose of the Study:

    • To compare the diagnostic accuracy of a 2-channel Holter system with bipolar V3- and V5-like leads against a conventional 12-lead ECG system during Bruce protocol treadmill exercise testing.
    • To evaluate the reliability of ambulatory monitoring in detecting exercise-induced ST segment depression and significant coronary artery disease.

    Main Methods:

    • 144 patients underwent simultaneous ECG recording via a 2-channel Holter (V3/V5-like leads) and a 12-lead system during a Bruce protocol treadmill test.

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  • Ischemic changes (ST depression) were analyzed for presence, severity, and timing.
  • 95 patients subsequently underwent coronary arteriography for correlation with diagnostic accuracy metrics (sensitivity, specificity, positive predictive value).

    • Main Results:

    • High concordance (96%) was observed between Holter and 12-lead ECG in detecting ST depression.
    • The Holter system demonstrated comparable sensitivity (81%) and specificity (85%) to the 12-lead ECG (84% sensitivity, 85% specificity) in identifying significant coronary artery disease.
    • The addition of a V3 lead to the Holter system improved ischemia detection by 10%.

    Conclusions:

    • A 2-channel Holter recording system utilizing V3- and V5-like leads is as accurate as the conventional 12-lead ECG system for detecting exercise-induced ischemic changes.
    • Ambulatory monitoring systems can reliably reproduce ST segment changes during exercise stress tests, offering a viable alternative for ischemia detection.
    • The findings support the use of ambulatory monitoring for assessing coronary artery disease during exercise.