Identification of septal ischemia during exercise by Q-wave analysis: Correlation with coronary angiography

Famularo, Michael A.; Paliwal, Yogesh; Redd, Robert M.; Ellestad, Myrvin H.

doi:10.1016/s0002-9149(83)80076-9

Cited by 29 publications

(15 citation statements)

References 16 publications

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“…Previous studies have showed that during exercise testing the Q wave amplitude may decrease, particularly in left anterior descending coronary artery stenosis, as a result of abnormal septal activation. 10,11) Wothuis, et al 12) studied ECG waveform changes in subjects at low risk for cardiovascular disorders and found that the average R wave amplitude increases during early exercise and then decreases during maximum effort and the average S wave amplitude becomes greater as exercise progresses. Also, Charlap, et al 13) showed that the S wave amplitude decreases during occlusion of LAD angioplasty.…”

Section: Discussionmentioning

confidence: 99%

<b>Comparison of Exercise QRS Amplitude Changes in Patients with Slow Coronary Flow Versus Significant Coronary Stenosis</b>

et al. 2004

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SUMMARYExercise Q, R, and S wave amplitude changes, called the QRS score, have been reported to be a marker of exercise-induced myocardial ischemia. Therefore, in this study, using the exercise QRS score, we sought to determine if slow coronary flow (SCF) phenomenon is associated with the exercise-induced myocardial ischemia.This retrospective study included 23 patients evaluated for suspected coronary artery disease and found to have SCF (group I) and 19 subjects with angiographically-defined significant coronary artery stenosis (group II). All study subjects underwent treadmill exercise testing using the modified Bruce protocol. For each subject the amplitude of the Q, R, and S waves in leads aVF and V 5 was measured manually using calipers before and immediately after exercise. The QRS score was calculated by subtracting the Q, R, and S wave differences in leads aVF and V 5 .There was no difference between the two groups with respect to demographic properties. The peak heart rate achieved, baseline and peak systolic-diastolic blood pressure, exercise duration, and the metabolic equivalent values were similar in both groups. The maximum ST-segment depression ratio was significantly lower in patients with SCF than those of significant coronary stenosis (0.8 ± 0.4 vs 1.3 ± 0.5 P = 0.001, respectively). However, the exercise QRS score was found to be similar in both groups (3.3 ± 2.3 vs 2.1 ± 3.0 P = 0.2, respectively).The data suggest that SCF phenomenon may alone lead to myocardial ischemia even in the absence of obstructed major epicardial coronary arteries as detected by similar exercise QRS scores to those of significant coronary artery stenosis. (Jpn Heart J 2004; 45: 419-428)

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Section: Discussionmentioning

confidence: 99%

<b>Comparison of Exercise QRS Amplitude Changes in Patients with Slow Coronary Flow Versus Significant Coronary Stenosis</b>

et al. 2004

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“…This has been related to abnormal septal activation, reflecting loss of contraction associated with ischemia. 9 The S-wave amplitude increases with exercise both in normal sub-378 jects and in patients with CAD. The less pronounced exerciseinduced increase of the S-wave amplitude in patients with CAD is attributed to subendocardial ischemia.…”

Section: Interpretation Of Results-possible Underlying Mechanismsmentioning

confidence: 99%

The prognostic value of a QRS score during exercise testing

Michaelides¹,

Aigyprladou²,

Andrikopoulos³

et al. 2005

Clin Cardiol

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SummaryBackground: Values of a QRS score have been positively related to the number of narrowed coronary arteries and to the extent of myocardial ischemia in radionuclide imaging techniques.Hypothesis: This study was conducted to evaluate the potential prognostic information of abnormal values of this QRS score during treadmill exercise testing in patients with established coronary artery disease (CAD).Methods: In all, 309 patients (258 men, 51 women, mean age 56.1 ± 10.0 years) with documented CAD, underwent a treadmill exercise test and coronary arteriography at baseline. Subsequently, they were prospectively followed to a maximum of 36 months (mean follow-up 23 ± 13 months, median 25 months).Results: During the follow-up period, 20 patients (6.5%) died from acute myocardial infarction. Abnormal QRS score values were found to be significantly and independently associated with cardiac mortality (QRS ≤ Ϫ4: relative risk 11.7; 95% confidence interval = 2.5-55.4; p = 0.002).Conclusions: Taking into consideration the importance of exercise testing in the management of ischemic heart disease, the use of this QRS score could be of clinical value in predicting the outcome of patients with documented CAD.

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“…So, Qwave amplitude has been reported to remain unchanged or fail to increase in patients with CHD. This phenomenon has been attributed to an abnormal septal activation, reflecting loss of contraction associated with ischemia due to narrowing of the LAD [4]. R wave amplitude has been reported to remain unchanged or increase with exercise in patients with CHD.…”

Section: Athens Qrs Scorementioning

confidence: 99%

“…R wave amplitude has been reported to remain unchanged or increase with exercise in patients with CHD. There are various physiological mechanisms associated with this alternation: a. increase in intracardiac blood, the so called "Brody Effect" [4], b. delay in intramyocardial conduction, caused by a progressive increase of the extra cellular potassium concentration in the ischemic myocardium [5], c. changes in heart rate, contractility and axis, and d. failure of the ischemic left ventricle to respond to adrenergic stimulation. Finally, S wave amplitude has been reported to increase both in normal subjects and in patients with CHD, but the magnitude of the increase in S wave amplitude is decreased in patients with CHD.…”

Section: Athens Qrs Scorementioning

confidence: 99%

The impact of novel exercise criteria and indices for the diagnostic and prognostic ability of exercise testing

Michaelides

Tousoulis

Raftopoulos

et al. 2010

International Journal of Cardiology

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Identification of septal ischemia during exercise by Q-wave analysis: Correlation with coronary angiography

Cited by 29 publications

References 16 publications

<b>Comparison of Exercise QRS Amplitude Changes in Patients with Slow Coronary Flow Versus Significant Coronary Stenosis</b>

<b>Comparison of Exercise QRS Amplitude Changes in Patients with Slow Coronary Flow Versus Significant Coronary Stenosis</b>

The prognostic value of a QRS score during exercise testing

The impact of novel exercise criteria and indices for the diagnostic and prognostic ability of exercise testing

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