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Significance of minor electrocardiographic repolarisation changes in asymptomatic subjects
Insights
Resting ECGs identified asymptomatic men with potential coronary artery disease (CAD). Exercise ECGs improved detection, but positive predictive value for CAD remained moderate, highlighting the need for further investigation.
Area of Science:
- Cardiology
- Preventive Medicine
- Diagnostic Imaging
Background:
- Routine electrocardiograms (ECGs) are used for screening in military personnel.
- Minor ST segment and T wave changes can be early indicators of cardiac issues.
- Asymptomatic individuals with resting ECG abnormalities require further cardiac assessment.
Purpose of the Study:
- To evaluate the diagnostic accuracy of exercise ECG in asymptomatic individuals with minor resting ECG changes.
- To determine the prevalence of coronary artery disease (CAD) in this population.
- To compare the predictive values of resting ECG versus exercise ECG for CAD detection.
Main Methods:
- Screening of 3000 routine ECGs in Armed Forces personnel over two years.
- Exercise ECG stress testing performed on 90 asymptomatic men with minor resting ECG abnormalities.
- Coronary arteriography conducted on 33 individuals with abnormal exercise ECG responses.
Main Results:
- Coronary artery disease (CAD) was confirmed in 14 out of 33 subjects who underwent coronary arteriography.
- Exercise ECG demonstrated a sensitivity of 87.5% and specificity of 74.3% for CAD detection.
- The positive predictive value for exercise ECG was 42.4%, while for resting ECG it was 15.5%.
Conclusions:
- Exercise ECG is a valuable tool for detecting coronary artery disease (CAD) in asymptomatic individuals with minor resting ECG changes.
- Despite improved sensitivity, the positive predictive value of exercise ECG suggests further diagnostic steps are often necessary.
- Resting ECG has a low positive predictive value for CAD in this specific asymptomatic cohort.
Abstract:
3000 routine ECGs were screened during a 2 year period in Armed Forces personnel reporting for annual medical examination. 90 asymptomatic men with minor ST segment and T wave changes at rest were assessed by exercise ECG. 33 responded abnormally. They were subjected to coronary arteriography. 14 subjects were confirmed to have coronary artery disease (CAD). 19 subjects had a false positive response and assuming a false negative response of 2%, a sensitivity of 87.5%, specificity of 74.3% and a positive predictive value of 42.4% is obtained for exercise ECG. A positive predictive value of 15.5% is obtained for the resting ECG.