Diagnostic value of ST-segment deviations during cardiac exercise stress testing: Systematic comparison of different ECG leads and time-points
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Diagnostic value of ST-segment deviations during cardiac exercise stress testing: Systematic comparison of different ECG leads and time-points. / Puelacher, Christian; Wagener, Max; Abächerli, Roger; Honegger, Ursina; Lhasam, Nundsin; Schaerli, Nicolas; Prêtre, Gil; Strebel, Ivo; Twerenbold, Raphael; Boeddinghaus, Jasper; Nestelberger, Thomas; Rubini Giménez, Maria; Hillinger, Petra; Wildi, Karin; Sabti, Zaid; Badertscher, Patrick; Cupa, Janosch; Kozhuharov, Nikola; du Fay de Lavallaz, Jeanne; Freese, Michael; Roux, Isabelle; Lohrmann, Jens; Leber, Remo; Osswald, Stefan; Wild, Damian; Zellweger, Michael J; Mueller, Christian; Reichlin, Tobias.
In: INT J CARDIOL, Vol. 238, 01.07.2017, p. 166-172.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Diagnostic value of ST-segment deviations during cardiac exercise stress testing: Systematic comparison of different ECG leads and time-points
AU - Puelacher, Christian
AU - Wagener, Max
AU - Abächerli, Roger
AU - Honegger, Ursina
AU - Lhasam, Nundsin
AU - Schaerli, Nicolas
AU - Prêtre, Gil
AU - Strebel, Ivo
AU - Twerenbold, Raphael
AU - Boeddinghaus, Jasper
AU - Nestelberger, Thomas
AU - Rubini Giménez, Maria
AU - Hillinger, Petra
AU - Wildi, Karin
AU - Sabti, Zaid
AU - Badertscher, Patrick
AU - Cupa, Janosch
AU - Kozhuharov, Nikola
AU - du Fay de Lavallaz, Jeanne
AU - Freese, Michael
AU - Roux, Isabelle
AU - Lohrmann, Jens
AU - Leber, Remo
AU - Osswald, Stefan
AU - Wild, Damian
AU - Zellweger, Michael J
AU - Mueller, Christian
AU - Reichlin, Tobias
N1 - Copyright © 2017 Elsevier B.V. All rights reserved.
PY - 2017/7/1
Y1 - 2017/7/1
N2 - BACKGROUND: Exercise ECG stress testing is the most widely available method for evaluation of patients with suspected myocardial ischemia. Its major limitation is the relatively poor accuracy of ST-segment changes regarding ischemia detection. Little is known about the optimal method to assess ST-deviations.METHODS: A total of 1558 consecutive patients undergoing bicycle exercise stress myocardial perfusion imaging (MPI) were enrolled. Presence of inducible myocardial ischemia was adjudicated using MPI results. The diagnostic value of ST-deviations for detection of exercise-induced myocardial ischemia was systematically analyzed 1) for each individual lead, 2) at three different intervals after the J-point (J+40ms, J+60ms, J+80ms), and 3) at different time points during the test (baseline, maximal workload, 2min into recovery).RESULTS: Exercise-induced ischemia was detected in 481 (31%) patients. The diagnostic accuracy of ST-deviations was highest at +80ms after the J-point, and at 2min into recovery. At this point, ST-amplitude showed an AUC of 0.63 (95% CI 0.59-0.66) for the best-performing lead I. The combination of ST-amplitude and ST-slope in lead I did not increase the AUC. Lead I reached a sensitivity of 37% and a specificity of 83%, with similar sensitivity to manual ECG analysis (34%, p=0.31) but lower specificity (90%, p<0.001).CONCLUSION: When using ECG stress testing for evaluation of patients with suspected myocardial ischemia, the diagnostic accuracy of ST-deviations is highest when evaluated at +80ms after the J-point, and at 2min into recovery.
AB - BACKGROUND: Exercise ECG stress testing is the most widely available method for evaluation of patients with suspected myocardial ischemia. Its major limitation is the relatively poor accuracy of ST-segment changes regarding ischemia detection. Little is known about the optimal method to assess ST-deviations.METHODS: A total of 1558 consecutive patients undergoing bicycle exercise stress myocardial perfusion imaging (MPI) were enrolled. Presence of inducible myocardial ischemia was adjudicated using MPI results. The diagnostic value of ST-deviations for detection of exercise-induced myocardial ischemia was systematically analyzed 1) for each individual lead, 2) at three different intervals after the J-point (J+40ms, J+60ms, J+80ms), and 3) at different time points during the test (baseline, maximal workload, 2min into recovery).RESULTS: Exercise-induced ischemia was detected in 481 (31%) patients. The diagnostic accuracy of ST-deviations was highest at +80ms after the J-point, and at 2min into recovery. At this point, ST-amplitude showed an AUC of 0.63 (95% CI 0.59-0.66) for the best-performing lead I. The combination of ST-amplitude and ST-slope in lead I did not increase the AUC. Lead I reached a sensitivity of 37% and a specificity of 83%, with similar sensitivity to manual ECG analysis (34%, p=0.31) but lower specificity (90%, p<0.001).CONCLUSION: When using ECG stress testing for evaluation of patients with suspected myocardial ischemia, the diagnostic accuracy of ST-deviations is highest when evaluated at +80ms after the J-point, and at 2min into recovery.
KW - Aged
KW - Electrocardiography/instrumentation
KW - Exercise Test/methods
KW - Female
KW - Follow-Up Studies
KW - Heart Rate/physiology
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Perfusion Imaging/methods
KW - ST Elevation Myocardial Infarction/diagnostic imaging
KW - Time Factors
U2 - 10.1016/j.ijcard.2017.02.079
DO - 10.1016/j.ijcard.2017.02.079
M3 - SCORING: Journal article
C2 - 28320607
VL - 238
SP - 166
EP - 172
JO - INT J CARDIOL
JF - INT J CARDIOL
SN - 0167-5273
ER -
