High-frequency QRS analysis compared to conventional ST-segment analysis in patients with chest pain and normal ECG referred for exercise tolerance test

Conti, Alberto; Alesi, Andrea; Aspesi, Giovanna; Bernardis, Niccolò De; Bianchi, S.; Coppa, Alessandro; Donnini, Chiara; Grifoni, Caterina; Becucci, Alessandro; Casula, Claudia

doi:10.5603/cj.a2015.0001

Cited by 8 publications

(8 citation statements)

References 33 publications

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“…This is in line with a previous study by Conti et al, who found a similar prognostic value of HF-QRS in 337 patients undergoing exercise stress testing. 34 Particular strengths and limitations of the HF-QRS technology merit consideration. The potential of automated test interpretation in cardiology is well known 8,35 and automatically computed ECG markers with improved diagnostic accuracy that are simple, readily available and interpretable by a wide range of healthcare professionals are an unmet clinical need.…”

Section: Discussionmentioning

confidence: 99%

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

Schaerli

Abächerli

Walter

et al. 2020

European Heart Journal. Acute Cardiovascular Care

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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.

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Section: Discussionmentioning

confidence: 99%

“…This is in line with a previous study by Conti et al, who found a similar prognostic value of HF-QRS in 337 patients undergoing exercise stress testing. 34…”

Section: Discussionmentioning

confidence: 99%

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

Schaerli

Abächerli

Walter

et al. 2020

European Heart Journal. Acute Cardiovascular Care

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“…Nghiên cứu lâm sàng do nhóm tác giả Conti và cộng sự [13] Nhồi máu cơ tim được chẩn đoán dựa trên chỉ số HFMI là tỷ lệ phần trăm giữa diện tích phần RAZ so với diện tích bên dưới đường bao của phức bộ HFQRS và có thể được tính bằng công thức sau:…”

Section: Mở đầUunclassified

“…Một bản ghi ECG được coi là thiếu máu cục bộ nếu phát hiện ít nhất 3 chuyển đạo thiếu máu cục bộ và đồng thời chỉ số HFMI được chẩn đoán trong ít nhất 5 chuyển đạo, hoặc giá trị chỉ số HFMI (được tính trung bình từ 6 chuyển đạo có chỉ số HFMI lớn nhất) có giá trị lớn hơn 9%. Hiệu suất của thuật toán đề xuất cũng được so sánh với kết quả được công bố trong 3 thử nhiệm lâm sàng (Toledo [10], Conti [13], Galante [14]). Cả 3 nghiên cứu lâm sàng đều chỉ ra được lợi ích của việc sử dụng tín hiệu ECG tần số cao trong quá trình chẩn đoán bệnh thiếu máu cơ tim.…”

Section: Mở đầUunclassified

“…Kết quả phát hiện thành công nhồi máu cơ tim bị ảnh hưởng bởi quy mô của bệnh nhân tham gia xét nghiệm và tỷ lệ giữa bệnh nhân nhồi máu cơ tim và đối tượng khỏe mạnh trong quần thể xét nghiệm. Giá trị tiên đoán dương tính và âm tính cho thấy các đối tượng khỏe mạnh chiếm ưu thế trong nghiên cứu của Conti [13]. Ngược lại, trong nghiên cứu của Toledo [10] và của chúng tôi, ECG ghi nhận từ bệnh nhân nhồi máu cơ tim chiếm ưu thế.…”

Section: Kết Quả Và Thảo Luậnunclassified

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Automatic Detection of Myocardial Infarction Based on High-Frequency QRS Analysis

Manh

Thang²

2020

NST

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In this paper, we present an algorithm for automatic detection of myocardial infarction using high-frequency components of the ECG signal. Firstly, the QRS complexes and their boundaries are identified. Then, the correlation matrix between the detected QRS complexes in each lead is determined to eliminate noises and ectopic oscillations. The dominant QRS complexes are finally determined using cluster analysis. These resulting values are averaged to have a unique representative QRS complex in a given lead. This averaged signal is then passed through a band-pass filter to obtain high-frequency components of the QRS complex. Finally, the High-Frequency Morphological Index (HFMI) for each lead is calculated and diagnosed with myocardial infarction based on decision rules. The performance of the proposed algorithm is evaluated on signals from the PTB database. The obtained results show that the proposed method reached satisfactory performance compared with the results from clinical studies. Keywords: Myocardial infarction, High-frequency ECG, RAZ, RMS, HFMI.

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The combination of high‐frequency QRS and ST‐segment alterations during exercise stress tests enhanced the diagnostic efficacy for coronary artery disease

Liu,

Du,

Wei

et al. 2024

Clinical Cardiology

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BackgroundHigh‐frequency QRS (HF‐QRS) manifests as a novel adjunct electrocardiographic marker with potential utility in coronary artery disease (CAD) detection.HypothesisWe hypothesize that HF‐QRS analysis may be superior to conventional ST‐segment analysis in detecting CAD, and the combination of these two analyses in the exercise stress test may enhance the diagnostic efficacy for CAD.MethodsThe study incorporated a sample of 157 patients (mean age 62 9 years) referred for nonemergent angiography. Before angiography, patients underwent exercise stress testing utilizing an upright bicycle. High‐resolution electrocardiogram (ECG) data were collected during the exercise test, facilitating both HF‐QRS and conventional ST‐segment analyses. The diagnostic efficacy of HF‐QRS and ST‐segment analysis were compared, utilizing angiographic outcomes as the gold standard. The study design integrated HF‐QRS analysis and ST‐segment analysis via sequential and concurrent testing protocols.ResultsIn terms of CAD detection, HF‐QRS analysis displayed superior sensitivity compared to conventional ST‐segment analysis (63% vs. 37%, p = .002). The serial test significantly increased specificity from 79% to 97% (p = .002) compared to ST‐deviation analysis alone. It showed a markedly low sensitivity of 26%. The parallel test significantly increased sensitivity from 37% to 77% (p < .001), while retaining a moderate level of specificity of 51%. The quantity of ECG leads exhibiting a positive HF‐QRS response demonstrated a correlation with the severity of CAD (p < .001).ConclusionsHF‐QRS analysis exhibited superior sensitivity in detecting angiographically confirmed CAD relative to conventional ST‐segment analysis. Moreover, the combination of HF‐QRS and ST‐segment alterations during exercise stress test enhanced the diagnostic efficacy for CAD.

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High-frequency QRS analysis compared to conventional ST-segment analysis in patients with chest pain and normal ECG referred for exercise tolerance test

Abstract: Background: The novel analysis of high-frequency QRS components (HFQRS-analysis) has been proposed in patients with chest pain (CP) and normal electrocardiography (ECG) referred for exercise tolerance test (ex-ECG HFQRS (area: 0.655, ST-segment-analysis. (Cardiol J 2015; 22, 2: 141-149)

Cited by 8 publications

References 33 publications

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

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

Automatic Detection of Myocardial Infarction Based on High-Frequency QRS Analysis

The combination of high‐frequency QRS and ST‐segment alterations during exercise stress tests enhanced the diagnostic efficacy for coronary artery disease

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