Skip to main content

Advertisement

Log in

Detection of coronary artery stenosis after successful percutaneous coronary intervention by dipyridamole stress portable type signal-averaged electrocardiography: a prospective study

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

In our previous studies, using portable type signalaveraged electrocardiography (portable SAECG) with dipyridamole stress we reported that patients with coronary artery disease were identified at the bedside with high sensitivity and specificity. In this study we prospectively investigated whether coronary artery stenosis after successful percutaneous coronary intervention (PCI) could be detected. Standard 12-lead QRS wave SAECG was performed before and after dipyridamole stress at the bedside in 61 patients 8.0 ± 9.4 months after successful PCI for myocardial infarction or angina pectoris (46 males and 15 females, mean age 66 ± 12 years). The filtered QRS duration (fQRSd) before and after dipyridamole stress was determined by the multiphasic oscillation method at each lead of the standard 12 leads, and the maximal value of changes in fQRSd (MAX ΔfQRSd) among the 12 leads was determined. The positive test was defined as MAX ΔfQRSd ≥5 ms, and negative as MAX ΔfQRSd <5 ms based on our previous studies. Then selective coronary arteriography was performed. In the positive group (n = 24), 21 patients had stenosis (≥50%) of the coronary artery and 3 did not. In the negative group (n = 37), 8 patients had stenosis and 29 did not. The sensitivity, specificity, positive predictive accuracy, and negative predictive accuracy for the detection of coronary artery stenosis by SAECG were 72%, 91%, 88%, and 78%, respectively. Dipyridamole stress portable SAECG is useful to detect patients with coronary artery stenosis after successful PCI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Serruys PW, Jaegere P, Kiemeneij F, Macaya C, Rutsch W, Heyndrickx G, Emanuelsson H, Marco J, Legrand V, Materne P, Belardi J, Sigwart U, Colombo A, Goy JJ, Heuvel P, Delcan J, Morel MA (1994) A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. N Engl J Med 331:489–495

    Article  PubMed  CAS  Google Scholar 

  2. Fischman DL, Leon MB, Baim DS, Schatz RA, Savage MP, Penn I, Detre K, Veltri L, Ricci D, Nobuyoshi M, Cleman M, Heuser R, Almond D, Teirstein PS, Fish RD, Colombo A, Brinker J, Moses J, Shaknovich A, Hirshfeld J, Bailey S, Ellis S, Rake R, Goldberg S (1994) A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med 331:496–501

    Article  PubMed  CAS  Google Scholar 

  3. Ozaki Y, Violaris AG, Serruys PW (1996) New stent technologies. Prog Cardiovasc Dis 39:129–140

    Article  PubMed  CAS  Google Scholar 

  4. Committee Members, Task Force Members (1999) ACC/AHA Guidelines for Coronary Angiography. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guideline (Committee on Coronary Angiography). J Am Coll Cardiol 33:1756–1816

    Article  Google Scholar 

  5. Honan MB, Bengtson JR, Pryor DB, Rendall DS, Stack RS, Hinohara T, Skelton TN, Califf RM, Hlatky MA, Mark DB (1989) Exercise treadmill testing is a poor predictor of anatomic restenosis after angioplasty for acute myocardial infarction. Circulation 80: 1585–1594

    PubMed  CAS  Google Scholar 

  6. Committee Members, Task Force Members (1997) ACC/AHA Guidelines for Exercise Testing: Executive summary. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 96:345–354

    Google Scholar 

  7. Garzon P, Eisenberg MJ (2001) Functional testing for the detection of restenosis after percutaneous transluminal coronary angioplasty: A meta-analysis. Can J Cardiol 17:41–48

    CAS  Google Scholar 

  8. Heinle SK, Lieberman EB, Ancukiewicz M, Waugh RA, Bashore TM, Kisslo J (1993) Usefulness of dobutamine echocardiography for detecting restenosis after percutaneous transluminal coronary angioplasty. Am J Cardiol 72:1220–1225

    Article  PubMed  CAS  Google Scholar 

  9. Hamlin RL, Pipers FS, Hellerstein HK, Smith CR (1968) QRS alterations immediately following production of left ventricular free-wall ischemia in dog. Am J Physiol 215:1032–1040

    PubMed  CAS  Google Scholar 

  10. Holland RP, Brooks H (1976) The QRS complex during myocardial ischemia. An experimental analysis in the porcine heart. J Clin Invest 57:541–550

    Article  PubMed  CAS  Google Scholar 

  11. Hill JL, Gettes LS (1980) Effect of acute Coronary artery occlusion on local myocardial extracellular K+ activity in swine. Circulation 61:768–778

    PubMed  CAS  Google Scholar 

  12. David D, Naito M, Michelson E, Watanabe Y, Chen CC, Morgaroth J, Shaffenburg M, Blenko T (1982) Intramyocardial conduction: A major determinant of R-wave amplitude during acute myocardial ischemia. Circulation 65:161–167

    PubMed  CAS  Google Scholar 

  13. Barnhill JE, Wikswo JP, Dawson AK, Gundersen S, Robertson RS, Robertson D, Virmani R, Smith RF (1985) The QRS complex during transient myocardial ischemia: study in a canine preparation. Circulation 71:901–911

    PubMed  CAS  Google Scholar 

  14. Morimoto S, Kato S, Hiramitsu S, Uemura A, Ohtsuki M, Kato Y, Sugiura A, Miyagishima K, Yoshida Y, Hishada H (2006) Role of myocardial interstitial edema in conduction disturbances in acute myocarditis. Heart Vessels 21:356–360

    Article  PubMed  Google Scholar 

  15. Ahnve S, Sullivan M, Myers J, Froelicher V (1986) Computer analysis of exercise-induced changes in QRS prolongation in patients with angina pectoris and in normal subjects. Am Heart J 111:903–908

    Article  PubMed  CAS  Google Scholar 

  16. Michaelides AP, Boudoulas H, Antonakoudis H, Vyssoulis GP, Toutouzas PK (1992) Effect of a number of coronary arteries significantly narrowed and status of intraventricular conduction on exercise-induced QRS prolongation in coronary artery disease. Am J Cardiol 70:1487–1489

    Article  PubMed  CAS  Google Scholar 

  17. Michaelides A, Ryan JM, VanFossen D, Pozderac R, Boudoulas H (1993) Exercise-induced QRS prolongation in patients with coronary artery disease: A marker of myocardial ischemia. Am Heart J 126:1320–1325

    Article  PubMed  CAS  Google Scholar 

  18. Berntsen RF, Gjestvang FT, Rasmussen K (1995) QRS prolongation as a indicator of risk of ischemia-related ventricular tachycardia and fibrillation induced by exercise. Am Heart J 129:542–548

    Article  PubMed  CAS  Google Scholar 

  19. Freedman RA, Gillis AM, Keren A, Soderhold-Difatte V, Mason JW (1985) Signal-averaged electrocardiographic late potentials in patients with ventricular fibrillation or ventricular tachycardia: correlation with clinical arrhythmia and electrophysiologic study. Am J Cardiol 55:1350–1353

    Article  PubMed  CAS  Google Scholar 

  20. Buxton AE, Simson MB, Falcone RA, Marchlinski FE, Doherty JU, Josephson ME (1987) Results of signal-averaged electrocardiography and electrophysiologic study in patients with nonsustained ventricular tachycardia after healing of acute myocardial infarction. Am J Cardiol 60:80–85

    Article  PubMed  CAS  Google Scholar 

  21. Matsumoto M, Hiraki T, Yoshida T, Hamada T, Ohga M, Ikeda H, Imaizumi T (2005) Portable type signal-averaged electrocardiography with dipyridamole. A new and convenient method to detect patients with coronary artery disease and ischemia. Circ J 69: 6:659–665

    Article  PubMed  Google Scholar 

  22. Otsubo H, Yoshida T, Hiraki T, Inage T, Matsumoto M, Imaizumi T (2006) Portable-type signal-averaged electrocardiography with dipyridamole to detect patients with coronary artery disease. A prospective study. Circ J 70:12:1568–1573

    Article  PubMed  Google Scholar 

  23. Albro PC, Gould KL, Westcott RJ, Hamilton GW, Ritchie JL, Williams DL (1978) Noninvasive assessment of coronary stenoses by myocardial imaging during pharmacologic coronary vasodilation. Clinical trial. Am J Cardiol 42:751–760

    CAS  Google Scholar 

  24. Yoshida T, Ikeda H, Hiraki T, Kubara I, Ohga M, Imaizumu T (1999) Detection of concealed left sided accessory atrioventricular pathway by P wave signal averaged electrocardiogram. J Am Coll Cardiol 33:55–62

    Article  PubMed  CAS  Google Scholar 

  25. Subcommittee members, task force members (1987) Guidelines for Coronary Angiography: A Report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures. J Am Coll Cardiol 10:935–950

    Google Scholar 

  26. Miller DD, Verani MS (1994) Current status of myocardial perfusion imaging after percutaneous transluminal coronary angioplasty. J Am Coll Cardiol 24:260–266

    Article  PubMed  CAS  Google Scholar 

  27. Dori G, Denekamp Y, Fishman S, Bitterman H (2003) Exercise stress testing, myocardial perfusion imaging and stress echocardiography for detecting restenosis after successful percutaneous transluminal coronary angioplasty; a review of performance. J Intern Med 253:253–262

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Teruhisa Yoshida.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ohe, M., Yoshida, T., Hiraki, T. et al. Detection of coronary artery stenosis after successful percutaneous coronary intervention by dipyridamole stress portable type signal-averaged electrocardiography: a prospective study. Heart Vessels 23, 40–46 (2008). https://doi.org/10.1007/s00380-007-1010-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-007-1010-0

Key words

Navigation