Predictive value of changes in R-wave amplitude after exercise in coronary heart disease

Poyatos, María Elena; Lerman, Jorge; Estrada, A.Q.; Chiozza, Miguel; Perosio, A M

doi:10.1016/s0002-9149(84)80069-7

Cited by 16 publications

(7 citation statements)

References 20 publications

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“…In addition to ST segment changes, ischemia may cause a rapid tran sient increase in R-wave amplitude [23]. On-line VCG monitoring of QRS changes may therefore provide addi tional information to monitoring of ST changes.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Information from On-Line Vectorcardiography in Unstable Angina Pectoris

Lundin

Eriksson

Fredrïkson³

et al. 1995

Cardiology

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The prognostic information from 24-hour monitoring with on-line vectorcardiography (VCG) was assessed in 100 patients with a clinical diagnosis of unstable angina pectoris. ST change vector magnitude, ST vector magnitude and QRS vector difference were monitored. During a follow-up period of 343 ± 77 days, 7 patients died from cardiac causes and 8 patients had a nonfatal myocardial infarction (MI). Thirty patients were readmitted for unstable angina pectoris and 36 were revascularized because of medical refractory angina. Univariate predictors of cardiac death or nonfatal MI included greater age, rest pain during hospitalization, previous MI, diabetes mellitus and high incidence of supposedly ischemic transient ST and QRS vector changes. In multivariate analysis, a high incidence of transient ST (p < 0.01) and QRS (p < 0.01) vector changes provided additional prognostic information beyond that of clinical and exercise test data. In conclusion, VCG monitoring during the first 24 h of hospitalization for unstable angina pectoris identifies patients with increased risk of adverse cardiac events.

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Section: Discussionmentioning

confidence: 99%

Prognostic Information from On-Line Vectorcardiography in Unstable Angina Pectoris

Lundin

Eriksson

Fredrïkson³

et al. 1995

Cardiology

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“…In significant contrast, even though the overall change of the QRS complex (QRS-vd) was not significantly different from that of the N-group, the magnitude in the Y-lead changed very little, and QRS-int tended to increase in the TI-group (Figs 2 and 3). Increased QRS amplitudes during exercise have been correlated to ischaemic heart disease in a wealth of studies (including Bonoris et al, 1978;Berman et al, 1980;Poyatos et al, 1984;Michaelides et al, 1990). However, the subject is still controversial, as several groups have been unable to confirm these findings (including Simoons, 1979;Van Eenige et al, 1982;Myers et al, 1985).…”

Section: The Qrs Magnitudementioning

confidence: 99%

Ischaemic heart disease and the changes in the QRS and ST segments during exercise: a pilot study with a novel vectorcardiographic system

Pilhall

Riha

Jern

1992

Clinical Physiology

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In order to find new ischaemic parameters, the spatial changes of the Frank vectorcardiogram were continuously analysed with a new, highly precise vectorcardiographic method during, and immediately after a maximal exercise test. This was done in 18 young healthy males, and 18 patients with scintigraphic reversible ischaemia. During exercise, different patterns between the groups were noted for the changes in the mean QRS magnitude in the Y-lead (P less than 0.005), the QRS-integral (P less than 0.05), and the QRS-duration (P less than 0.05). Immediately after exercise, several QRS parameters in the normal group continued to change according to the same pattern as during exercise (P less than 0.05), which was in contrast with the patterns of the ischaemic group (P less than 0.01). The spatial ST difference at J+20 ms discriminated well between the groups, especially when corrected for QRS-magnitudes at rest and heart rate (P less than 0.0005). In short, this pilot study supports previous findings in that changes in amplitude and duration of the QRS complex during exercise discriminated between healthy young males and patients with ischaemic heart disease. Moreover, rapid discriminating changes were seen in the QRS segment during cessation of exercise. These changes deserve attention since they may be of importance for the conflicting results on the diagnostic value of QRS changes during exercise.

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“…Many studies have shown that exercise-induced de creased or increased R wave amplitude may be observed in normal individuals [16,17] and in patients with CAD [5,18] and in patients with normal or abnormal left ven tricular function respectively [9,10]. Although changes in R wave amplitude normally occur in sinus beats during exercise, we have also observed that R wave amplitude in supraventricular extrasystoles induced with exercise may differ from that of the preceding sinus beat ( fig.…”

Section: Diagnostic Value Of Exercise-induced Ecg Changes In Sinus Bementioning

confidence: 48%

Improved Diagnostic Accuracy with the Evaluation of ECG Changes in Exercise-Induced Supraventricular Extrasystoles

Michaelides¹,

Vyssoulis²,

Psomadaki³

et al. 1994

Am J Noninvas Cardiol

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The clinical value of exercise-induced ST segment depression (ST(x)) and R wave amplitude (R(x)) in supraventricular extrasystoles, in the preceding sinus beat (ST(s) and Rs respectively), as well as the combination of the differences between the two of them (ST(x-s) + R(x-s)) was studied in 96 patients with angiographically documented coronary artery disease (CAD) (group A) - 34 with myocardial infarction (group Ai) and 62 without (group A(2)) - compared to 37 subjects with normal coronary arteries (group B). ST(x-s) had greater values in group A than in group B (0.4 ± 0.5 vs. -0.2 ± 0.4 mm; p < 0.0001) as did R (0.6 ± 0.5 vs.-1.1 ± 0.8 mm; p< 0.0001) and their combination (1.0 ± 0.7 vs.-1.3 ± 1.0 mm; p < 0.0001), while ST(x-s) had similar values in groups Ai and A(2) but R(x-s) values were higher in Ai than in A(2) (p< 0.001). R(x-s), ST(x-s) and especially their sum (ST(x-s) + R(x-s)) value was directly related to the number of vessel disease (0.7 ± 0.5 mm for 1-, 1.1 ± 0.7 mm for 2-, and 1.4 ± 0.7 mm for 3-vessel disease; p < 0.0001), while it was significantly higher in patients with left ventricular dysfunction (-0.01 ± 1.2 vs. 1.5 ± 0.8 mm; p< 0.0001). The value of (ST(x-s) + R(x-s)) improved sensitivity compared to the sinus signs (from 66 to 87%) as well as specificity (from 82 to 95%) for CAD detection, while for detection of left ventricular dysfunction it improved sensitivity (from 85 to 91%) with no gain in specificity. It is concluded that ST segment depression and R wave amplitude changes in exercise-induced supraventricular extrasystoles may be of greater diagnostic significance than in sinus beats, for the detection of CAD and left ventricular dysfunction.

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Predictive value of changes in R-wave amplitude after exercise in coronary heart disease

Cited by 16 publications

References 20 publications

Prognostic Information from On-Line Vectorcardiography in Unstable Angina Pectoris

Prognostic Information from On-Line Vectorcardiography in Unstable Angina Pectoris

Ischaemic heart disease and the changes in the QRS and ST segments during exercise: a pilot study with a novel vectorcardiographic system

Improved Diagnostic Accuracy with the Evaluation of ECG Changes in Exercise-Induced Supraventricular Extrasystoles

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