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Septal Q wave in exercise testing: angiographic correlation

H Morales-Ballejo, P S Greenberg, M H Ellestad

    The American Journal of Cardiology
    |August 1, 1981
    PubMed
    Summary
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    Septal Q wave amplitude in lead CM5 is a valuable predictor of coronary artery disease. Low or absent Q waves, especially after exercise, indicate ischemia and improve diagnostic accuracy when combined with S-T depression.

    Area of Science:

    • Cardiology
    • Diagnostic Imaging
    • Exercise Physiology

    Background:

    • Coronary artery disease (CAD) diagnosis relies on various indicators.
    • Septal Q waves in electrocardiography (ECG) may offer insights into myocardial health.

    Purpose of the Study:

    • To evaluate the diagnostic utility of septal Q wave response in lead CM5 for predicting coronary artery disease.
    • To compare the effectiveness of septal Q waves versus S-T segment depression in stress testing.

    Main Methods:

    • Measured septal Q wave amplitude in lead CM5 in 50 CAD patients and 50 controls before and after exercise.
    • Correlated ECG findings with coronary angiography results.
    • Calculated sensitivity, specificity, and predictive values for both S-T depression and Q wave responses.

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    Main Results:

    • Septal Q waves were smaller in CAD patients at rest and post-exercise (p<0.001).
    • Absent or small Q waves were more frequent in CAD patients (76% rest, 82% post-exercise).
    • Q wave analysis showed higher sensitivity (82%) and specificity (88%) than S-T depression (52%, 74%).

    Conclusions:

    • Low septal Q wave voltage and failure to increase post-exercise suggest abnormal septal activation due to ischemia.
    • Septal Q wave assessment is a sensitive and specific marker for ischemia.
    • Combining Q wave and S-T responses enhances diagnostic sensitivity to 92%.