A comparison of the diagnostic performance of the ST/HR hysteresis with cardiopulmonary stress testing parameters in detecting exercise-induced myocardial ischemia

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• 作者：Marco Zimarino ; Luca Barnabei ; Rosalinda Madonna ; Giuseppe Palmieri ; Francesco Radico ; Alfonso Tatasciore ; Francesco Iachini Bellisarii ; Gianni Mauro Perrucci ; Aless ; ro Corazzini ; Raffaele De Caterina
• 关键词：Exercise stress testing ; ST/HR hysteresis ; Cardiopulmonary exercise testing ; Myocardial ischemia
• 刊名：International Journal of Cardiology
• 出版年：2013
• 出版时间：30 September, 2013
• 年：2013
• 卷：168
• 期：2
• 页码：1274-1279
• 全文大小：489 K

文摘

Background

Because ST segment depression has limited diagnostic performance at exercise electrocardiography (ECG), ST segment depression/heart rate (ST/HR) hysteresis and cardiopulmonary exercise test (CPET)-derived parameters have been proposed as alternatives to diagnose exercise-induced myocardial ischemia. We compared the diagnostic performance of such parameters.

Methods

We studied 56 subjects (45 men, 11 women, age 59.7 ¡À 13.6 years) referred for suspected exercise-induced myocardial ischemia with an equivocal ECG exercise test. All subjects serially underwent CPET and a myocardial single-photon emission computerized tomography (SPECT) perfusion imaging (as the gold standard for ischemia). Maximum ST depression at peak exercise (ST-max), the ST/HR hysteresis, ¦¤VO₂/¦¤WR b-b₁ slope, ¦¤VO₂/¦¤WR (aa₁-bb₁), VO₂/HR flattening duration and other CPET parameters were derived in all subjects.

Results

On the basis of SPECT, 23 subjects (41 % ) were considered ischemic and 33 subjects (59 % ) non-ischemic. ST/HR hysteresis was higher (0.026 mV; 95 % CI: 0.003 to 0.049 vs ? 0.016 mV; 95 % CI: ? 0.031 to ? 0.001 mV) and ST-max was lower (? 0.105 mV; 95 % CI: ? 0.158 to ? 0.052 vs 0.032 mV; 95 % CI: ? 0.001 to ? 0.066 mV) in ischemic vs non-ischemic subjects (P = 0.004 and P = 0.001, respectively). Among CPET parameters, ¦¤VO₂/¦¤WR b-b¹ slope was lower (9.4 ¡À 3.8) and ¦¤VO₂/¦¤WR (aa¹-bb¹) was higher (2.1 ¡À 2.6) in ischemic vs non-ischemic subjects (11.4 ¡À 2.3, P = 0.005, and 1.1 ¡À 1.5, P = 0.001, respectively). The ST/HR hysteresis had the highest area under the curve value, better (P < 0.05) than any other parameters tested, thus showing the highest overall diagnostic performance.

Conclusion

The ST/HR hysteresis is superior to CPET-derived parameters for detecting exercise-induced myocardial ischemia in patients with equivocal ECG exercise test results.