Exercise and pharmacologic stress-induced interlead T-wave heterogeneity analysis to detect clinically significant coronary artery stenosis.
Int J Cardiol
; 298: 32-38, 2020 01 01.
Article
em En
| MEDLINE
| ID: mdl-31412992
ABSTRACT
BACKGROUND:
Despite widespread use of ETT and vasodilator-stress with myocardial perfusion imaging (MPI) for noninvasive detection of flow-limiting coronary artery disease, there is continued need to improve diagnostic accuracy. We examined whether measurement of interlead T-wave heterogeneity (TWH) during exercise tolerance testing (ETT) or pharmacologic stress testing improves detection of stenoses in large epicardial coronary arteries.METHODS:
All 137 patients at our institution who underwent diagnostic coronary angiography within 0 to 5â¯days after ETT (Nâ¯=â¯81) or dipyridamole IV infusion (Nâ¯=â¯58) in 2016 were studied, including 2 patients with both tests. Cases (Nâ¯=â¯93) had angiographically significant stenosis (≥50% of left main orâ¯≥â¯70% of an epicardial coronary artery ≥2â¯mm in diameter); controls (Nâ¯=â¯44) did not. TWH, i.e., interlead splay of T waves, was determined by second central moment analysis from precordial leads by an investigator blinded to angiographic results.RESULTS:
At rest, TWH levels were similar for cases and controls. ETT and dipyridamole stress testing increased TWH by 69% (pâ¯<â¯0.0001) and 27% (pâ¯<â¯0.0001), respectively, in cases. In controls, TWH did not change. Areas under the ROC curves for TWH increase for any flow-limiting coronary artery stenosis were 0.737 (pâ¯<â¯0.0001) for ETT and 0.818 (pâ¯<â¯0.0001) for dipyridamole stress testing. By contrast, neither ST-segment changes during ETT (pâ¯=â¯0.12) nor MPI during dipyridamole stress testing (pâ¯=â¯0.60) discriminated cases from controls.CONCLUSIONS:
TWH measurement is a novel method that improves detection of angiographically confirmed flow-limiting stenoses in large epicardial coronary arteries during both ETT and MPI during pharmacologic stress testing with dipyridamole.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Tolerância ao Exercício
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Estenose Coronária
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Eletrocardiografia
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Teste de Esforço
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Imagem de Perfusão do Miocárdio
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article