Exercise-induced QRS prolongation in patients with mild coronary artery disease: Computer analysis of the digitized multilead ECGs |
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| Institution: | 1. Department of Cardiovascular Dynamics, National Cardiovascular Center Research Institute, Suita, Osaka, Japan;2. Division of Cardiology, National Cardiovascular Center, Suita, Osaka, Japan;1. Unité de physiologie des APS, faculté des sciences, université de Douala, 7064 Bassa Douala, Cameroun;2. Institut de recherches médicales et d’études des plantes médicinales (IMPM), BP 13033, Yaoundé, Cameroun;3. Service de cardiologie, hôpital de Bonassama-Douala, Douala, Cameroun;1. Department of Physics, Jishou University, Jishou 416000, China;2. The Collaborative Innovation Center of Manganese-Zinc-Vanadium Industrial Technology, Jishou University, Jishou 416000, China;3. College of Information and Electronic Engineering, Hunan City University, Yiyang 413000, China;1. Laboratory of Catalysis and Catalytic Processes, Dipartimento di Energia, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy;2. Department of Chemistry, Materials and Chemical Engineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy;1. Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;2. Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania;1. Department of Thermal and Fluids Engineering, Universidad Carlos III de Madrid, Leganés 28911, Spain;2. Department of Chemical & Biomolecular Engineering, National Fuel Cell Research Center, University of California Irvine, Irvine, CA 92697, USA |
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| Abstract: | Although exercise-induced QRS prolongation has been reported as a possible marker for inducible ischemia, subtleness of the prolongation makes it unidentifiable from standard, chart-recorded electrocardiograms (ECGs). To overcome such a limitation, we measured the QRS width using high-resolution ECGs and examined the diagnostic value of the exercise-induced QRS prolongation in patients before and after percutaneous transluminal coronary angioplasty (PTCA). In 16 patients with single- (n = 12) or double-vessel disease (n = 4), treadmill exercise ECG tests were performed before and after PTCA, while continuously recording 8-lead ECGs at 500 Hz. The onset of the QRS complexes was defined by the earliest deflection, and the end was defined as the latest deflection among 8 leads with the use of algebraic sum of the absolute voltage and their time derivatives (dV/dt) from all 8 leads. We compared QRS complexes before and 1 minute after exercise. Before PTCA, exercise prolonged the QRS width in all but 3 patients (unchanged in 2, decreased in 1) (84 ± 7 to 87 ± 8 ms, P < .005). After PTCA, it decreased in 4, was unchanged in 5, and increased in 7 (83 ± 7 to 83 ± 6 ms, not significant). PTCA shortened postexercise QRS width in all but 3 (unchanged in 2, increased in 1: 83 ± 6 to 87 ± 8 ms, P < .001). High-resolution ECGs enabled us to measure subtle QRS prolongation induced by mild ischemia. Because the QRS prolongation and ST-segment changes would reflect different aspects of myocardial ischemia, incorporating this measure into ST segment criteria might significantly improve the diagnostic accuracy for coronary artery disease. |
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