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Holter recording during treadmill testing in assessing myocardial ischemic changes
Insights
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.
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.
- 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.
Abstract:
One hundred forty-four patients underwent a Bruce protocol treadmill exercise test during which an electrocardiogram (ECG) was recorded simultaneously with a 2-channel Holter recorder with bipolar V3- and V5-like leads and by a conventional 12-lead system. Sixty-eight patients had no ST depression on either the Holter or on the 12-lead ECG during the exercise test, whereas in 70 patients ischemic changes were recorded by both methods; thus, in 138 of the 144 patients (96%), the results of the 2 tests were concordant. The severity of ST depression, as judged by the heart rate at which ischemic changes were first noted and the maximal ST depression observed, were similar on both recording systems. The Holter system identified 6 of the 7 patients whose ischemic changes were confined to the inferior wall on the 12-lead ECG. The addition of the V3 lead as a second ischemic lead increased the ischemia detection by 10%. Ninety-five patients also underwent coronary arteriography. In these patients the sensitivity of the Holter system during exercise in detecting significant coronary artery disease was 81% and that of 12-lead ECG was 84%, the specificity was 85% and 85%, respectively, and the positive predictive value 91% and 91%, respectively. Thus, the 2-channel Holter recording system with bipolar V3- and V5-like leads was as accurate as the 12-lead system in detecting ischemic changes during exercise and proved that ambulatory monitoring system can reliably reproduce ST segment.