lschaemic heart disease: The QRS score: a promising new exercise score for detecting coronary artery disease based on exercise-induced changes of Q-, R- and S-waves: a relationship with myocardial ischaemia

Campen, C. M. C. van; Visser, Frans C.; Visser, Cees A.

doi:10.1093/oxfordjournals.eurheartj.a014936

Cited by 28 publications

(35 citation statements)

References 15 publications

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“…Also, Charlap, et al 13) showed that the S wave amplitude decreases during occlusion of LAD angioplasty. Van Campen, et al 14) reported that an abnormal QRS score reflects myocardial ischemia and the QRS score decreases as the number of vessels increases.…”

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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“…11 QRS-score values have been shown to be unrelated to exercise-induced ST segment and they have a higher predictive accuracy in patients with CAD, as reported in previous studies. [3][4][5] In particular, negative (< 0) scores were always associated with CAD, while a QRS score < 5 mm predicted CAD with sensitivity ranging from 75 to 86% and specificity ranging from 73 to 79%, values significantly higher than those of ST-segment depression (62 and 70%). Moreover, applying the Bayes' theorem, the combination of an abnormal QRS-score and ST-segment depression resulted in the highest post-test risk for CAD, and a normal QRS score without ST-segment depression in the lowest post-test risk.…”

Section: Interpretation Of Results-possible Underlying Mechanismsmentioning

confidence: 92%

“…All deaths, sudden or nonsudden, that occurred in the context of this study were due to cardiac causes. All 20 study patients who died within the 3-year follow-up period, had been submitted to our institution 16 or to other affiliated institutions, 4 and the cause of death was documented as "cardiac" in their death certificates by qualified medical personnel.…”

Section: Resultsmentioning

confidence: 99%

“…3 The calculation of the QRS score from leads aVF and V 5 has been tested in other cohorts by independent investigators with similar results. 4,5 Coronary arteriography and left ventriculography were performed according to the applicable guidelines. 7 The interpretation was performed by two investigators who were blinded to exercise testing results.…”

Section: Methodsmentioning

confidence: 99%

“…3 So far, this index has been positively related, not only to the number of narrowed coronary arteries, but also to the extent of myocardial ischemia in radionuclide imaging techniques. 4 Furthermore, from the diagnostic point of view, this score was proposed as a clinically useful predictor for the presence or absence of significant coronary stenosis. 5 In clinical practice, however, risk assessment and prognostic stratification direct all patient management decisions.…”

Section: Introductionmentioning

confidence: 99%

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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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