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Evaluation of signal-averaged cardiokymography for the detection of ischaemic left ventricular dysfunction
A W Scherhag1, S Pfleger, C Ceconi
1I. Medical Clinic, Faculty for Clinical Medicine Mannheim, University of Heidelberg, Germany.
Insights
Signal-averaged cardiokymography (CKG) shows potential in detecting patients with ischaemic ventricular dysfunction. Its sensitivity for identifying left ventricular wall motion abnormalities (WMA) is linked to the severity of myocardial ischaemia.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Technology
Background:
- Coronary artery disease (CAD) diagnosis often requires invasive procedures.
- Non-invasive methods for detecting myocardial ischaemia are highly sought after.
- Cardiokymography (CKG) offers a non-invasive approach to assess cardiac function.
Purpose of the Study:
- To evaluate the feasibility, sensitivity, and specificity of a new signal-averaged CKG system.
- To detect pharmacologically induced ischaemic left ventricular wall motion abnormalities (WMA).
- To assess CKG performance during pharmacologic stress echocardiography (SE) in patients with suspected CAD.
Main Methods:
- Recorded precordial CKG curves in 100 consecutive patients undergoing dobutamine-SE.
- Classified CKG curves into three types based on systolic outward motion.
- Defined a positive CKG test as a change in baseline type at peak stress, indicating myocardial ischaemia.
Main Results:
- The CKG test demonstrated a sensitivity of 67% (18/27) for detecting pathological dobutamine-SE.
- The specificity of the CKG test was 83% (57/69) in patients with normal SE.
- True positive CKG results correlated with a greater number of echocardiographic segments showing WMA.
Conclusions:
- Signal-averaged CKG can identify patients with ischaemic ventricular dysfunction.
- CKG sensitivity for WMA detection is influenced by the extent of left ventricular ischaemia.
- Further research is required to establish the definitive diagnostic value of signal-averaged CKG for suspected CAD.
Unlabelled:
Cardiokymography (CKG) is a non-invasive method for the detection of patients with coronary artery disease (CAD). Issues of the present study were to evaluate the feasibility, sensitivity and specificity of a recently developed signal-averaged CKG system for detecting patients with pharmacologically induced ischaemic left ventricular wall motion abnormalities (WMA) during pharmacologic stress echocardiography (SE). Precordial CKG curves were recorded in 100 consecutive patients who underwent dobutamine-SE for suspected CAD. For interpretation, CKG curves were classified into three different types, depending on the degree of systolic outward motion. CKG test results were regarded as positive (indicating myocardial ischaemia) if there was a change of the baseline CKG type at peak pharmacologic stress. The CKG test results were positive in 18 of 27 patients with a pathologic dobutamine-SE (sensitivity 67%), but did not show any change of the prior CKG type in 57 of 69 patients with a normal SE (specificity 83%). Patients with a true positive CKG test had significantly (P<0.05) more echocardiographic segments with WMA than patients with a false negative CKG test.
Conclusions:
Signal-averaged CKG can detect patients with ischaemic ventricular dysfunction. Sensitivity of CKG in detecting patients with WMA depends on the extent of left ventricular ischaemia. Further studies are needed to define the diagnostic value of signal-averaged CKG in the non-invasive detection of patients with suspected CAD.