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Related Experiment Videos

Multiple-lead QRS changes with exercise testing. Diagnostic value and hemodynamic implications

J L Berman, J Wynne, P F Cohn

    Circulation
    |January 1, 1980
    PubMed
    Summary
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    Exercise-induced increases in R waves across multiple ECG leads (epsilon R) combined with ST segment changes strongly indicate coronary artery disease. This finding highlights epsilon R

    Area of Science:

    • Cardiology
    • Diagnostic Imaging
    • Exercise Physiology

    Background:

    • Chest pain syndromes are common clinical presentations requiring accurate diagnosis.
    • Exercise electrocardiography (ECG) is a standard tool for evaluating coronary artery disease (CAD).
    • The diagnostic utility of specific ECG changes during exercise, particularly QRS alterations, requires further elucidation.

    Purpose of the Study:

    • To assess the diagnostic accuracy of exercise-induced multiple-lead QRS changes (epsilon R) for coronary artery disease.
    • To determine the hemodynamic significance and correlation with left ventricular function.
    • To compare the diagnostic yield of epsilon R with traditional ST segment changes.

    Main Methods:

    • Prospective study of 230 patients with chest pain syndromes undergoing Bruce protocol exercise tests.

    Related Experiment Videos

  • Analysis of exercise ECGs for increases in R waves across multiple leads (epsilon R) and ST segment deviations.
  • Correlation of ECG findings with coronary angiography results, left ventricular function (end-diastolic pressure, asynergy, ejection fraction), and exercise parameters.

    • Main Results:

    • The presence of epsilon R plus ST segment change >1 mm identified coronary disease in 99% of patients, significantly higher than individual markers.
    • 85% of patients with epsilon R and ST changes had multivessel coronary artery disease.
    • Increased epsilon R correlated with abnormal left ventricular end-diastolic pressure, resting asynergy, and reduced ejection fraction, irrespective of ST changes.

    Conclusions:

    • Exercise-induced epsilon R, particularly when combined with ST segment changes, is a highly sensitive marker for diagnosing coronary artery disease.
    • The presence of epsilon R during exercise is associated with impaired left ventricular function and hemodynamic abnormalities.
    • Epsilon R may reflect underlying left ventricular dysfunction in patients with coronary artery disease.