Noninvasive diagnosis of coronary artery disease: the cardiokymographic stress test.

Abstract

Stress-induced abnormalities of regional left ventricular wall motion were assessed by cardiokymography (CKG) during the course of maximal treadmill exercise tests in 157 patients, of whom 122 subsequently underwent coronary angiography. Seventy patients had significant angiographic coronary artery disease and 52 were normal. Forty-one of the 70 patients developed greater than 0.1 mV ST-segment depression (ECG sensitivity 59%) and 52 of 70 patients developed abnormal systolic outward motion by CKG (CKG sensitivity 74%). Among the 52 normals, 36 had negative ECG stress tests (ECG specificity 69%) and 49 had normally sustained systolic inward motion by CKG (CKG specificity 94%). The stress CKG was normal in 15 of the 16 false-positive stress ECGs; the stress ECG was correctly normal in two of the three false-positive stress CKG tests. Only one normal patient had concordantly false-positive ECG and CKG tests. The predictive accuracy of concordant ECG and CKG interpretations was, therefore, higher than either test alone. These data suggest that regional wall motion abnormalities, which are sensitive and specific markers of myocardial ischemia, may be detected noninvasively by CKG. We concluded that CKG helps identify false-positive and false-negative ECG stress tests and improves the diagnostic accuracy of stress testing for detection of coronary artery disease.

Application of conditional probability analysis to the clinical diagnosis of coronary artery disease.

“…A resting 12-lead electrocardiogram was obtained in the upright and supine positions and during voluntary hyperventilation using a computerized Case Marquette ECG recording system. Cardiokymography (CKG)1 was performed in the supine position over the V3 precordial line between the fourth and fifth intercostal space, using a 5-cm capacitive transducer (9) …”

“…These test combinations include electrocardiographic stress testing (1)(2)(3), cardiac fluoroscopy (4-6), cardiokymography (7)(8)(9), and thallium scintigraphy (10)(11)(12). The rationale for a multiple test approach resides in the fact that the predictive accuracy of any one of these tests is quite low when applied to a population with low disease prevalence, whereas the accuracy of two or more tests is very high when all results are in agreement (6,9,(12)(13)(14)(15). However, the frequent occurrence of discordant test responses and the increased cost ofmultiple testing limit the ultimate usefulness of these formats.…”

“…Outward systolic motion was termed "holosystolic" if not preceded by inward motion during ejection, and was termed "midsystolic" if its magnitude was >50% of the preceding inward motion. Systolic motion was otherwise termed "normal" (9).…”

Implications for Anaesthesia of New Concepts in Cardiovascular Diseases: Discussion Paper

“…The noninvasive methods rely on radionuciides (radionuciide cineangiography), ultrasound (echocardiography) or magnetometry (cardiokymography). These methods are of proven value in the assessment of patients with coronary artery disease (Borer et al 1977, Silverberg et al 1980 and should be used systematically in the preoperative assessment of patients with significant coronary artery disease. Where substantial abnormalities of wall motion are present, the negative inotropy of most anaesthetic agents is likely to cause severe depression of global cardiac function.…”

Noninvasive Diagnosis of Coronary Artery Disease: A Comparison between Cardiokymographic and Electrocardiographic Stress Testing

“…Following the development of kinetocardiography by Eddleman et al [5]in the 1950s and the development of this technique to cardiokymography (CKG) by Vas and his team [6, 7, 8, 9]in the 1960s and 70s, exercise CKG was propagated as a method for noninvasive diagnosis of CAD in the 1980s [10, 11, 12, 13, 14]. The CKG system has been improved compared to the device used in earlier studies [10, 11, 12, 13, 14]and now allows curve analysis during the stress period.…”