Exercise and pharmacologic stress-induced interlead T-wave heterogeneity analysis to detect clinically significant coronary artery stenosis.

Autor: Silva AC; Beth Israel Deaconess Medical Center, Department of Medicine, Division of Cardiovascular Medicine, Boston, MA, United States of America; Harvard School of Public Health, Department of Environmental Sciences, Boston, MA, United States of America; Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil., de Antonio VZ; Beth Israel Deaconess Medical Center, Department of Medicine, Division of Cardiovascular Medicine, Boston, MA, United States of America; Harvard School of Public Health, Department of Environmental Sciences, Boston, MA, United States of America; Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil., Sroubek J; Beth Israel Deaconess Medical Center, Department of Medicine, Division of Cardiovascular Medicine, Boston, MA, United States of America; Harvard Medical School, Department of Medicine, Boston, MA, United States of America., Gervino E; Beth Israel Deaconess Medical Center, Department of Medicine, Division of Cardiovascular Medicine, Boston, MA, United States of America; Harvard Medical School, Department of Medicine, Boston, MA, United States of America., Ho K; Beth Israel Deaconess Medical Center, Department of Medicine, Division of Cardiovascular Medicine, Boston, MA, United States of America; Harvard Medical School, Department of Medicine, Boston, MA, United States of America., Medeiros SA; Beth Israel Deaconess Medical Center, Department of Medicine, Division of Cardiovascular Medicine, Boston, MA, United States of America; Harvard School of Public Health, Department of Environmental Sciences, Boston, MA, United States of America; Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil., Silva FT; Beth Israel Deaconess Medical Center, Department of Medicine, Division of Cardiovascular Medicine, Boston, MA, United States of America; Harvard School of Public Health, Department of Environmental Sciences, Boston, MA, United States of America; Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil., Pedreira GC; Beth Israel Deaconess Medical Center, Department of Medicine, Division of Cardiovascular Medicine, Boston, MA, United States of America; Harvard School of Public Health, Department of Environmental Sciences, Boston, MA, United States of America; Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil., Stocco FG; Beth Israel Deaconess Medical Center, Department of Medicine, Division of Cardiovascular Medicine, Boston, MA, United States of America; Harvard School of Public Health, Department of Environmental Sciences, Boston, MA, United States of America; Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil., Nearing BD; Beth Israel Deaconess Medical Center, Department of Medicine, Division of Cardiovascular Medicine, Boston, MA, United States of America; Harvard Medical School, Department of Medicine, Boston, MA, United States of America., Verrier RL; Beth Israel Deaconess Medical Center, Department of Medicine, Division of Cardiovascular Medicine, Boston, MA, United States of America; Harvard School of Public Health, Department of Environmental Sciences, Boston, MA, United States of America; Harvard Medical School, Department of Medicine, Boston, MA, United States of America. Electronic address: rverrier@bidmc.harvard.edu.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2020 Jan 01; Vol. 298, pp. 32-38. Date of Electronic Publication: 2019 Aug 07.
DOI: 10.1016/j.ijcard.2019.07.066
Abstrakt: Background: Despite widespread use of ETT and vasodilator-stress with myocardial perfusion imaging (MPI) for noninvasive detection of flow-limiting coronary artery disease, there is continued need to improve diagnostic accuracy. We examined whether measurement of interlead T-wave heterogeneity (TWH) during exercise tolerance testing (ETT) or pharmacologic stress testing improves detection of stenoses in large epicardial coronary arteries.
Methods: All 137 patients at our institution who underwent diagnostic coronary angiography within 0 to 5 days after ETT (N = 81) or dipyridamole IV infusion (N = 58) in 2016 were studied, including 2 patients with both tests. Cases (N = 93) had angiographically significant stenosis (≥50% of left main or ≥ 70% of an epicardial coronary artery ≥2 mm in diameter); controls (N = 44) did not. TWH, i.e., interlead splay of T waves, was determined by second central moment analysis from precordial leads by an investigator blinded to angiographic results.
Results: At rest, TWH levels were similar for cases and controls. ETT and dipyridamole stress testing increased TWH by 69% (p < 0.0001) and 27% (p < 0.0001), respectively, in cases. In controls, TWH did not change. Areas under the ROC curves for TWH increase for any flow-limiting coronary artery stenosis were 0.737 (p < 0.0001) for ETT and 0.818 (p < 0.0001) for dipyridamole stress testing. By contrast, neither ST-segment changes during ETT (p = 0.12) nor MPI during dipyridamole stress testing (p = 0.60) discriminated cases from controls.
Conclusions: TWH measurement is a novel method that improves detection of angiographically confirmed flow-limiting stenoses in large epicardial coronary arteries during both ETT and MPI during pharmacologic stress testing with dipyridamole.
(Copyright © 2019 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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