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

医学 心脏病学 QRS波群 内科学 狼牙棒 压力测试(软件) 心电图 复极 缺血 心肌灌注成像 临床终点 灌注 心肌梗塞 临床试验 传统PCI 电生理学 程序设计语言 计算机科学
作者
Nicolas Schaerli,Roger Abächerli,Joan Walter,Ursina Honegger,Christian Puelacher,Therese Rinderknecht,Deborah Müller,Jasper Boeddinghaus,Thomas Nestelberger,Ivo Strebel,Patrick Badertscher,Jeanne du Fay de Lavallaz,Raphael Twerenbold,Desiree Wussler,Johanna Hofer,Remo Leber,Christoph Kaiser,Stefan Osswald,Damian Wild,Michael J. Zellweger,Christian Mueller,Tobias Reichlin
出处
期刊:European heart journal. Acute cardiovascular care [Oxford University Press]
卷期号:9 (8): 836-847 被引量:9
标识
DOI:10.1177/2048872619842988
摘要

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.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<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<0.001). MACE-free survival was 90%, 80% and 42% in patients in the 'rule-out', intermediate and 'rule-in' groups (p<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.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.

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