scholarly journals Exercise-induced non-sustained ventricular tachycardia in
patients without significant findings during exercise stress
testing – what does it tell us?

2021 ◽  
Vol 16 (1-2) ◽  
pp. 10-10
Author(s):  
Edin Begić ◽  
Amer Iglica ◽  
Zijo Begić ◽  
Nedim Begić ◽  
Ada Đozić ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Stress Testing ◽  
Sustained Ventricular Tachycardia ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
Exercise Induced

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

2019 ◽  
Vol 9 (8) ◽  
pp. 836-847 ◽  
Author(s):  
Nicolas Schaerli ◽  
Roger Abächerli ◽  
Joan Walter ◽  
Ursina Honegger ◽  
Christian Puelacher ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Myocardial Ischaemia ◽  
High Frequency ◽  
Stress Testing ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
Deviation Analysis ◽  
Nuclear Myocardial Perfusion Imaging ◽  
Exercise Induced ◽  
Rule Out

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.

Abstract 14062: Accuracy of Exercise Induced St- Elevation in Lead Avr in the Diagnosis of Significant Left Main or Proximal Left Anterior Descending Artery Stenosis: A Systematic Review

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kirtipal S Bhatia ◽  
Subrat Das ◽  
Nirupama Krishnamurthi ◽  
Devika Aggarwal ◽  
vardhmaan jain ◽  
...  
Keyword(s):  
Stress Testing ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
Left Main ◽  
Mesh Terms ◽  
Lead Avr ◽  
St Elevation ◽  
Exercise Induced

Introduction: ST-segment changes during exercise stress testing are diagnostic of myocardial ischemia in patients with suspected coronary artery disease (CAD). Recent studies have shown that exercise-induced ST-elevation in aVR is associated with significant stenosis of the left main (LM) and proximal left anterior descending (pLAD) arteries Methods: Search of electronic databases (Embase, Medline, and Web of Science) using MeSH terms and keywords for exercise stress test, lead aVR and CAD was performed from inception through December 2019. 2 reviewers independently screened results in 2 stages: title/abstract followed by full text. Included studies had adult patients who underwent exercise stress testing and reported the performance of ST-elevation >1 mm in lead aVR for diagnosing significant LM or pLAD disease. Significant disease was defined as luminal narrowing >50% and >70% for LM and pLAD respectively. Pooled sensitivity, specificity, likelihood ratios (LR) and diagnostic odds ratios were calculated using a bivariate model, and a summary receiver operator curve (SROC) was constructed. Results: We included 6 studies with 1128 patients. The pooled sensitivity was 0.8 (95% CI 0.36-0.97; I 2 =94.7) and pooled specificity was 0.78 (95% CI 0.56-0.90; I 2 =97.8). Overall calculated positive LR was 3.56 (95% CI 2.34-5.4) and negative LR was 0.26 (95% CI 0.07-1.01). The pooled diagnostic odds ratio was 13.5 (95% CI 4.8-38.5). Hierarchical SROC curve showed an area under the curve of 0.84 (95% CI 0.81-0.87) (Figure 1). Conclusions: Our analysis showed moderate sensitivity and specificity of exercise-induced aVR ST-elevation for diagnosing significant LM or pLAD disease. The heterogeneity among studies was high, likely due to differences in patient selection. In conclusion, ST-elevation in aVR during exercise stress test increases the likelihood of having LM or pLAD disease. Large studies are needed to substantiate this finding.

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