Incremental value of high-frequency QRS analysis for diagnosis and prognosis in suspected exercise-induced myocardial ischaemia
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Incremental value of high-frequency QRS analysis for diagnosis and prognosis in suspected exercise-induced myocardial ischaemia. / 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.
In: EUR HEART J-ACUTE CA, Vol. 9, No. 8, 12.2020, p. 836-847.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Incremental value of high-frequency QRS analysis for diagnosis and prognosis in suspected exercise-induced myocardial ischaemia
AU - Schaerli, Nicolas
AU - Abächerli, Roger
AU - Walter, Joan
AU - Honegger, Ursina
AU - Puelacher, Christian
AU - Rinderknecht, Therese
AU - Müller, Deborah
AU - Boeddinghaus, Jasper
AU - Nestelberger, Thomas
AU - Strebel, Ivo
AU - Badertscher, Patrick
AU - du Fay de Lavallaz, Jeanne
AU - Twerenbold, Raphael
AU - Wussler, Desiree
AU - Hofer, Johanna
AU - Leber, Remo
AU - Kaiser, Christoph
AU - Osswald, Stefan
AU - Wild, Damian
AU - Zellweger, Michael J
AU - Mueller, Christian
AU - Reichlin, Tobias
PY - 2020/12
Y1 - 2020/12
N2 - AIM: 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.METHODS AND RESULTS: 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.CONCLUSION: 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.
AB - AIM: 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.METHODS AND RESULTS: 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.CONCLUSION: 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.
KW - Aged
KW - Diagnosis, Differential
KW - Electrocardiography
KW - Exercise/physiology
KW - Exercise Test/adverse effects
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Ischemia/diagnosis
KW - Prognosis
KW - Retrospective Studies
U2 - 10.1177/2048872619842988
DO - 10.1177/2048872619842988
M3 - SCORING: Journal article
C2 - 31008655
VL - 9
SP - 836
EP - 847
JO - EUR HEART J-ACUTE CA
JF - EUR HEART J-ACUTE CA
SN - 2048-8726
IS - 8
ER -
