The combination of high‐frequency QRS and ST‐segment alterations during exercise stress tests enhanced the diagnostic efficacy for coronary artery disease

Abstract

BackgroundHigh‐frequency QRS (HF‐QRS) manifests as a novel adjunct electrocardiographic marker with potential utility in coronary artery disease (CAD) detection.HypothesisWe hypothesize that HF‐QRS analysis may be superior to conventional ST‐segment analysis in detecting CAD, and the combination of these two analyses in the exercise stress test may enhance the diagnostic efficacy for CAD.MethodsThe study incorporated a sample of 157 patients (mean age 62 9 years) referred for nonemergent angiography. Before angiography, patients underwent exercise stress testing utilizing an upright bicycle. High‐resolution electrocardiogram (ECG) data were collected during the exercise test, facilitating both HF‐QRS and conventional ST‐segment analyses. The diagnostic efficacy of HF‐QRS and ST‐segment analysis were compared, utilizing angiographic outcomes as the gold standard. The study design integrated HF‐QRS analysis and ST‐segment analysis via sequential and concurrent testing protocols.ResultsIn terms of CAD detection, HF‐QRS analysis displayed superior sensitivity compared to conventional ST‐segment analysis (63% vs. 37%, p = .002). The serial test significantly increased specificity from 79% to 97% (p = .002) compared to ST‐deviation analysis alone. It showed a markedly low sensitivity of 26%. The parallel test significantly increased sensitivity from 37% to 77% (p < .001), while retaining a moderate level of specificity of 51%. The quantity of ECG leads exhibiting a positive HF‐QRS response demonstrated a correlation with the severity of CAD (p < .001).ConclusionsHF‐QRS analysis exhibited superior sensitivity in detecting angiographically confirmed CAD relative to conventional ST‐segment analysis. Moreover, the combination of HF‐QRS and ST‐segment alterations during exercise stress test enhanced the diagnostic efficacy for CAD.