Incremental value of high-frequency QRS analysis for diagnosis and prognosis in suspected exercise-induced myocardial ischaemia

Media type: E-Article
Title: Incremental value of high-frequency QRS analysis for diagnosis and prognosis in suspected exercise-induced myocardial ischaemia
Contributor: Schaerli, Nicolas; Abächerli, Roger; Walter, Joan; Honegger, Ursina; Puelacher, Christian; Rinderknecht, Therese; Müller, Deborah; Boeddinghaus, Jasper; Nestelberger, Thomas; Strebel, Ivo; Badertscher, Patrick; du Fay de Lavallaz, Jeanne; Twerenbold, Raphael; Wussler, Desiree; Hofer, Johanna; Leber, Remo; Kaiser, Christoph; Osswald, Stefan; Wild, Damian; Zellweger, Michael J; Mueller, Christian; Reichlin, Tobias
Published in: European Heart Journal. Acute Cardiovascular Care
Published: Oxford University Press (OUP), 2020
Language: English
DOI: 10.1177/2048872619842988
ISSN: 2048-8734; 2048-8726
Keywords: Cardiology and Cardiovascular Medicine ; Critical Care and Intensive Care Medicine ; General Medicine
Abstract: <jats:sec> <jats:title>Aim:</jats:title> <jats:p>Exercise stress testing is used to detect myocardial ischaemia, but is limited by low sensitivity and specificity. The authors investigated the value of the analysis of high-frequency QRS components as a marker of abnormal depolarization in addition to standard ST-deviations as a marker of abnormal repolarization to improve the diagnostic accuracy.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and results:</jats:title> <jats:p>Consecutive patients undergoing bicycle exercise stress nuclear myocardial perfusion imaging were prospectively enrolled. Presence of myocardial ischaemia, the primary diagnostic endpoint, was adjudicated using MPI and coronary angiography. Automated high-frequency QRS analysis was performed in a blinded fashion. The prognostic endpoint was major adverse cardiac events (MACEs) during two years of follow-up. Exercise-induced ischaemia was detected in 147/662 patients (22%). The sensitivity of high-frequency QRS was similar to ST-deviations (46% vs. 43%, p=0.59), while the specificity was lower (75% vs. 87%, p&lt;0.001). The combined use of high-frequency QRS and ST-deviations classified 59% of patients as ‘rule-out’ (both negative), 9% as ‘rule-in’ (both positive) and 32% in an intermediate zone (one test positive). The sensitivity for ‘rule-out’ and the specificity for ‘rule-in’ improved to 63% and 97% compared with ST-deviation analysis alone (both p&lt;0.001). MACE-free survival was 90%, 80% and 42% in patients in the ‘rule-out’, intermediate and ‘rule-in’ groups (p&lt;0.001). After adjustment for age, gender, ST-deviations and clinical post-test probability of ischaemia, high-frequency QRS remained an independent predictor for the occurrence of MACEs.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion:</jats:title> <jats:p>The use of high-frequency QRS analysis in addition to ST-deviation analysis improves the diagnostic accuracy during exercise stress testing and adds independent prognostic information.</jats:p> </jats:sec>
Description: <jats:sec>
<jats:title>Aim:</jats:title>
<jats:p>Exercise stress testing is used to detect myocardial ischaemia, but is limited by low sensitivity and specificity. The authors investigated the value of the analysis of high-frequency QRS components as a marker of abnormal depolarization in addition to standard ST-deviations as a marker of abnormal repolarization to improve the diagnostic accuracy.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods and results:</jats:title>
<jats:p>Consecutive patients undergoing bicycle exercise stress nuclear myocardial perfusion imaging were prospectively enrolled. Presence of myocardial ischaemia, the primary diagnostic endpoint, was adjudicated using MPI and coronary angiography. Automated high-frequency QRS analysis was performed in a blinded fashion. The prognostic endpoint was major adverse cardiac events (MACEs) during two years of follow-up. Exercise-induced ischaemia was detected in 147/662 patients (22%). The sensitivity of high-frequency QRS was similar to ST-deviations (46% vs. 43%, p=0.59), while the specificity was lower (75% vs. 87%, p&lt;0.001). The combined use of high-frequency QRS and ST-deviations classified 59% of patients as ‘rule-out’ (both negative), 9% as ‘rule-in’ (both positive) and 32% in an intermediate zone (one test positive). The sensitivity for ‘rule-out’ and the specificity for ‘rule-in’ improved to 63% and 97% compared with ST-deviation analysis alone (both p&lt;0.001). MACE-free survival was 90%, 80% and 42% in patients in the ‘rule-out’, intermediate and ‘rule-in’ groups (p&lt;0.001). After adjustment for age, gender, ST-deviations and clinical post-test probability of ischaemia, high-frequency QRS remained an independent predictor for the occurrence of MACEs.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusion:</jats:title>
<jats:p>The use of high-frequency QRS analysis in addition to ST-deviation analysis improves the diagnostic accuracy during exercise stress testing and adds independent prognostic information.</jats:p>
</jats:sec>
Footnote:
Access State: Open Access

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