Exercise and pharmacologic stress-induced interlead T-wave heterogeneity analysis to detect clinically significant coronary artery stenosis

The search for non-invasive markers of cardiac diseases comes back to the 12-lead electrocardiogram

“…Finally, on a general note independent of the discussed studies [8,9], we also believe that every new proposal of T wave morphology…”

“…This prevents addressing the question of whether myocardial ischemia was the most likely mechanism responsible for arrhythmic deaths in this population. In the present study [9], that investigated a limited number of patients with chronic CAD, no follow-up outcomes are reported thus excluding the possibility of combining T wave heterogeneity with clinical arrhythmia incidence. The finding that an increased ventricular repolarization heterogeneity was superior to either exercise or pharmacological stress test in predicting significant coronary stenosis is surely of interest but deserves further confirmation in larger populations.…”

“…In the present issue of the journal, the group of technology inventors report an interesting albeit rather small study in which they investigated whether interlead T-wave heterogeneity during exercise tolerance testing or pharmacologic stress testing could improve the detection of significant coronary artery stenoses in patients with chronic coronary artery disease (CAD) [9]. The authors observed that T wave heterogeneity levels at rest were similar for cases and controls.…”

T‐wave heterogeneity in standard resting 12‐lead ECGs is associated with 90‐day cardiac mortality in women following emergency department admission: A nested case–control study

“…Recently, we reported that T‐wave heterogeneity (TWH), a quantitative measure of the interlead splay of T waves among adjacent leads, correlates with malignant ventricular arrhythmias in preclinical studies (Bonatti et al., 2014; Nearing & Verrier, 2003) and strongly predicts cardiac mortality in clinical studies (Araujo Silva et al., 2020; Bortolotto et al., 2020; Kenttä et al., 2016; Silva et al., 2020; Tan et al., 2017; Verrier & Huikuri, 2017). In a 5600‐subject Health Survey 2000 study, TWH predicted all‐cause mortality and sudden cardiac death in a cross section of the entire Finnish population (Kenttä et al., 2016).…”

“…Recently, this laboratory reported that TWH can detect the presence of acute myocardial ischemia verified by single‐photon emission computed tomography during myocardial perfusion imaging and diagnostic coronary angiography (Araujo Silva et al., 2020). TWH was able to detect clinically significant coronary stenosis during pharmacologic stress and exercise tolerance testing, while ST‐segment changes did not distinguish between cases and controls (Araujo Silva et al., 2020; Silva et al., 2020). Finally, preimplantation TWH was found superior to QRS complex duration in predicting mechanical super‐response in patients with non‐left bundle branch block who received cardiac resynchronization therapy (Bortolotto et al., 2020).…”