Novel methodology for the detection of exercise-induced myocardial wall motion abnormalities by surface electrocardiogram during exercise test

Abstract Background We investigated whether ischemia-induced wall motion abnormalities during exercise test modify electrical vector variation. Methods We performed treadmill exercise test and thallium 201 scintigraphy in 150 normotensives. Beat-to-beat change of direction of S wave in V1 (reference...

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Bibliographic Details
Published in:Journal of electrocardiology 2011-05, Vol.44 (3), p.377-382
Main Authors: Michaelides, Andreas P., MD, FESC, Massias, Spyros, MD, Antoniades, Charalambos, MD, Tsiachris, Dimitris, MD, Dilaveris, Polychronis, MD, FESC, Aggelis, Athanasios, MD, Liakos, Charalampos, MD, Marinou, Kyriakoula, MD, Raftopoulos, Leonidas, MD, Soulis, Dimitrios, MD, Stefanadis, Christodoulos, MD, FESC
Format: Article
Language:English
Subjects:
Cardiovascular
Chi-Square Distribution
Electrocardiogram
Electrocardiography - methods
Exercise Test
Female
Humans
Ischemia
Male
Middle Aged
Myocardial Ischemia - diagnostic imaging
Myocardial Ischemia - physiopathology
ROC Curve
Sensitivity and Specificity
Statistics, Nonparametric
Thallium Radioisotopes
Tomography, Emission-Computed, Single-Photon
Wall motion abnormalities
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Summary:Abstract Background We investigated whether ischemia-induced wall motion abnormalities during exercise test modify electrical vector variation. Methods We performed treadmill exercise test and thallium 201 scintigraphy in 150 normotensives. Beat-to-beat change of direction of S wave in V1 (reference lead) was compared with that of R wave in V5 and aVF, representative of anterior and inferior walls, respectively. The percentage of neighboring QRS couples where S wave in V1 and R wave in V5 or aVF change toward the same direction (increase or decrease) constitutes V1-V5 and V1-aVF indexes. Results V1-V5 and V1-aVF indexes were significantly decreased in subjects with reversible anterior or inferior ischemia, respectively. A decrease in V1-V5 index ≥0.14 defines those with anterior wall ischemia (sensitivity, 100%; specificity, 75.5%), whereas a decrease in V1-aVF index ≥0.05 defines those with inferior wall ischemia (sensitivity, 92.3%; specificity, 61.5%). Conclusions These novel electrocardiographic exercise test indexes improved significantly their sensitivities.
ISSN:0022-0736
1532-8430
DOI:10.1016/j.jelectrocard.2010.11.011