New coronary artery disease index based on exercise-induced QRS changes

Michaelides, Andreas; Triposkiadis, Filippos; Boudoulas, Harisios; Spanos, Anastasios; Papadopoulos, Petros; Kourouklis, Kostas V.; Toutouzas, Pavlos

doi:10.1016/0002-8703(90)90072-6

Cited by 48 publications

(69 citation statements)

References 56 publications

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“…32) The Athens QRS score was found to be unrelated to exercise-induced STsegment depression and its sensitivity and specificity in predicting CAD were found to be higher than the ST-segment depression ratio. 8) In this context, although the maximum ST segment ratio was found to be lower in the SCF group than in those with coronary stenosis, a similar QRS score may indicate the presence of exercise-induced ischemia in patients with SCF. Study limitations: There are limitations to this study that may influence the results.…”

Section: Discussionmentioning

confidence: 79%

“…Michealides, et al 8) reported that an Athens QRS score of 5 mm predicted CAD with sensitivity ranging from 73% to 86% and a specificity ranging from 73% to 79%, values which were higher than that of ST segment depression (62% and 70). Accordingly, Cin, et al 28) using a cut off point of < 5 mm for mild to moderate risk patients and a cut off point of < 3 mm for high risk patients showed that in patients with a QRS score < 5 mm, CAD is significant and extensive during coronary angiography and concluded that there is a significant relationship between the QRS score and the extent of CAD.…”

Section: Discussionmentioning

confidence: 98%

“…However, the value of this marker was proven to be limited due to varying sensitivity and specificity. [5][6][7] Therefore, Michaelides, et al 8) proposed a new parameter, called the QRS score, to improve the efficacy of exercise testing. They showed that exercise-induced changes in the QRS complex provide a useful index not only for diagnosis but also for assessment of the severity of coronary artery disease.…”

Section: Discussionmentioning

confidence: 99%

“…However, exercise-induced ST-segment depression only has a sensitivity of 50% to 70% and a specificity of 70% to 90% as a diagnostic indicator. [5][6][7] For this reason, Michaelides, et al 8) developed the Athens QRS score, which combines exercise-induced changes in amplitude of Q, R, and S waves in order to improve the accuracy of an exercise electrocardiogram in the detection of coronary artery disease. In this study, we measured the exercise Athens QRS score in patients with SCF and compared it to those with significant coronary stenosis to determine if SCF phenomenon is associated with myocardial ischemia.…”

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confidence: 99%

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<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: 79%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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<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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“…3 The QRS score was derived from leads aVF and V 5 because, according to the relevant original paper, it was better related to the number of obstructed coronary arteries than the QRS score derived from other leads or their combinations. 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.…”

Section: Methodsmentioning

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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Gentile¹,

Tighe²

2019

Pocket Guide to Stress Testing

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New coronary artery disease index based on exercise-induced QRS changes

Cited by 48 publications

References 56 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

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