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Temporal electrical heterogeneity for detecting coronary artery disease: results in a heterogeneous cardiac
1Department of Cardiology, Cleveland Clinic Foundation, OH 44195.
Insights
A new 22-lead electrocardiographic test shows promise for screening coronary artery disease (CAD). The temporal electrical heterogeneity (TEH) index may help identify patients with significant CAD.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Electrocardiography
Background:
- A novel 22-lead electrocardiographic test is proposed for coronary artery disease (CAD) screening.
- Its accuracy is comparable to stress electrocardiography in select patient groups.
Purpose of the Study:
- To assess the accuracy of the 22-lead test in detecting CAD.
- To evaluate its utility in patients undergoing coronary angiography for diverse cardiac conditions.
Main Methods:
- Prospective study of 70 patients without angina or Q waves on resting ECG.
- Measurement of the temporal electrical heterogeneity (TEH) index at rest.
- Coronary angiography performed to confirm or exclude significant CAD (≥70% stenosis).
Main Results:
- Twenty-six of 70 patients (37%) had significant CAD.
- A TEH index ≥80 demonstrated 58% sensitivity, 75% specificity, and 58% positive predictive value.
- Mean TEH index was higher in patients with CAD (77.2) versus without (65.5, P=.02), despite similar clinical profiles.
Conclusions:
- The TEH index shows potential as a screening tool for CAD in a mixed cardiac patient population.
- Further large-scale studies are required for validation before widespread clinical adoption.
Background:
A new 22-lead electrocardiographic test has been advocated as a screening tool for coronary artery disease and has been shown to have accuracy similar to stress electrocardiography in specific patient populations.
Objective:
To determine the accuracy of this test for detecting coronary artery disease in patients undergoing coronary angiography for a variety of cardiac conditions.
Methods:
We prospectively determined the temporal electrical heterogeneity (TEH) index at rest in 70 patients who had no angina or Q waves on the resting 12-lead electrocardiogram before they underwent coronary angiography.
Results:
Twenty-six of the 70 patients had significant coronary artery disease, defined as 70% stenosis or greater in at least one major epicardial coronary artery. A TEH index of 80 or more had a sensitivity of 58%, a specificity of 75%, and a positive predictive value of 58%. The group with significant coronary disease had a mean TEH index of 77.2, and the group without coronary disease had a mean index of 65.5 (P = .02), despite similar clinical characteristics and indications for angiography.
Conclusion:
The TEH index shows promise as a screening tool for coronary artery disease in a heterogeneous cardiac population. However, larger studies are needed before it can be endorsed for widespread clinical use.