Utility of nonspecific resting electrocardiographic features for detection of coronary artery stenosis by Computed Tomography in acute chest pain patients: from the ROMICAT trial

  • Quynh A. Truong
  • Dahlia Banerji
  • Leon M. Ptaszek
  • Carolyn Taylor
  • Joao D. Fontes
  • Matthias Kriegel
  • Thomas Irlbeck
  • John T. Nagurney
  • Udo Hoffmann
Original Paper

Abstract

Twelve-lead surface electrocardiography (ECG) and computed tomography (CT) are used to evaluate for myocardial ischemia and coronary artery disease (CAD), respectively. We aimed to determine features on resting ECG that predict coronary artery stenosis by cardiac CT. In 309 acute chest pain patients, we compared the initial triage resting ECG to contrast-enhanced 64-slice cardiac CT angiography. We assessed for 6 quantitative (QT interval, QTc interval, QTc > 440 ms, gender-specific QTc, QT dispersion and QRS duration) and 4 qualitative ECG parameters (ST depression >0.05 to ≤0.1 mV, T wave inversion ≥0.1 mV, T wave flattening, and any T wave abnormalities) and for the presence of coronary stenosis by CT (>50% luminal narrowing). Specificities of these ECG parameters were excellent (83.6–97.0%) while sensitivities were poor (12.2–29.3%). For coronary stenosis detection, the ECG features with the greatest performance were the presence of ST depression (positive likelihood ratio [LR+] 4.09) and T wave inversion (LR+ 4.58). In multivariable analyses, the risk for coronary stenosis increased by 33–41% for every 20 ms prolongation of the QTc interval after adjusting for age, gender, and cardiac risk factors or adjustment for Framingham risk score. Similarly, there was an increase of fourfold with the presence of ST depression >0.05 to ≤0.1 mV or T wave inversion ≥0.1 mV. In acute chest pain patients, resting ECG features of QTc interval prolongation, mild ST depression, and T wave inversion are independently associated with the presence of CT coronary stenosis and their presence suggests an increase risk of CAD.

Keywords

Electrocardiography Coronary artery stenosis Computed tomography Acute chest pain Emergency department 

Abbreviations

CT

Computed tomography

ECG

Electrocardiography

CAD

Coronary artery disease

BMI

Body mass index

PPV

Positive predictive value

NPV

Negative predictive value

Notes

Acknowledgments

This work was supported by the NIH R01HL080053, and in part supported by Siemens Medical Solutions and General Electrics Healthcare. Dr. Truong received support from NIH grants L30HL093896 and 1K23HL098370.

Conflict of interests

No conflicts of interest to be disclosed.

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Copyright information

© Springer Science+Business Media, B.V. 2011

Authors and Affiliations

  • Quynh A. Truong
    • 1
    • 2
  • Dahlia Banerji
    • 1
  • Leon M. Ptaszek
    • 2
  • Carolyn Taylor
    • 1
  • Joao D. Fontes
    • 1
  • Matthias Kriegel
    • 1
  • Thomas Irlbeck
    • 1
  • John T. Nagurney
    • 3
  • Udo Hoffmann
    • 1
  1. 1.Cardiac MR PET CT ProgramMassachusetts General Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Division of CardiologyMassachusetts General Hospital, Harvard Medical SchoolBostonUSA
  3. 3.Department of Emergency MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonUSA

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