Korean Circ J.  2013 Oct;43(10):674-680. 10.4070/kcj.2013.43.10.674.

Improved Detection of Ischemic Heart Disease by Combining High-Frequency Electrocardiogram Analysis with Exercise Stress Echocardiography

• Choi JO
• Chang SA
• Park SJ
• Lee SC
• Park SW

• KMID: 1826558
• DOI: http://doi.org/10.4070/kcj.2013.43.10.674

Abstract

BACKGROUND AND OBJECTIVES
Because the exercise treadmill test (ETT) based on ST-segment analysis is limited due to low sensitivity and specificity, there has been an interest in the additional analysis of high-frequency components of QRS (HFQRS) for the detection of coronary artery disease (CAD). We sought to evaluate the feasibility and clinical usefulness of HFQRS analysis during exercise stress echocardiography (ESE).
SUBJECTS AND METHODS
We evaluated 175 patients (age 57+/-9,118 men) who performed ESE and either coronary computed tomographic angiography or coronary angiography. ETT was performed using the HyperQ stress system for both conventional ST-segment analysis and HFQRS intensity analysis.
RESULTS
Thirty-two patients (31%) had significant CAD. The sensitivity and specificity of HFQRS analysis were 68.8% and 74.8%, respectively. The combined model, including HFQRS analysis and ESE, provided the best diagnostic accuracy, with the area under the receiver-operating characteristics curve (AUC) of 0.948 {95% confidence interval (CI)=0.913-0.984} compared with ST-segment analysis (AUC 0.679, 95% CI=0.592-0.766).
CONCLUSION
HFQRS analysis during ESE is feasible and may provide additional diagnostic information for the detection of significant CAD.

Keyword

Treadmill test; Echocardiography, stress; Electrocardiography; Coronary artery disease

MeSH Terms

Angiography
Coronary Angiography
Coronary Artery Disease
Echocardiography, Stress*
Electrocardiography*
Exercise Test*
Humans
Myocardial Ischemia*
Sensitivity and Specificity
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Flowchart of enrollment of study patients. CAG: coronary angiography, CCTA: coronary computed tomographic angiography, HCM: hypertrophic cardiomyopathy, CABG: coronary artery bypass graft surgery, RWMA: regional wall motion abnormality, RBBB: right bundle branch block, IVCD: intraventricular conduction delay, ECG: electrocardiography, HFQRS: high-frequency components of QRS.

• 

  Fig. 2 Schematic flowchart of high-frequency QRS analysis and representative case. Modified from figures by Sharir et al.8) ECG: electrocardiography, HFQRS: high-frequency components of QRS.

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  Fig. 3 Receiver operational characteristic (ROC) curves for the diagnosis of significant coronary artery disease. Note the incremental value of HFQRS and/or ESE over ST-segment analysis and clinical variables. HFQRS: high frequency QRS analysis, ESE: exercise stress echocardiography.

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