Key result
Exercise-induced QRS score shows no diagnostic advantage over ST depression for CAD in women.
Why the study?
Exercise electrocardiography is widely used to diagnose coronary artery disease, but its diagnostic accuracy in women is limited.
Does the QRS score during exercise electrocardiography accurately diagnose coronary artery disease in women?
Observational (n=332)
No
Does the QRS score during exercise electrocardiography accurately diagnose coronary artery disease in women?
The QRS score and ST-segment depression during exercise ECG provide only moderate diagnostic accuracy for predicting coronary artery disease in women.
Moderate accuracy precludes routine CAD diagnosis by QRS score in women; leaves open incremental value over ST depression in prospective studies.
BACKGROUND: Exercise electrocardiography is a widely used diagnostic modality for diagnosing coronary artery disease. This method has been used for both sexes; however, its diagnostic accuracy in women is limited. METHODS: The study analyzed 332 women participating in the Finnish Cardiovascular Study. Among 332 women, 125 with angiographically proven coronary artery disease (mean age 62.1 ± 9.5 years), 91 with a low likelihood of coronary artery disease (mean age 47.3 ± 13.5 years), and 116 without angiographically proven coronary artery disease (mean age 56.3 ± 9.9 years) were analyzed. The Q, R, S, and ST-segment changes and QRS score were determined by subtracting the Q, R, S, and ST-segment amplitudes immediately after the maximal exercise changes from their rest values (Δ). Receiver operating characteristic curve analysis was performed to evaluate the overall diagnostic performance of the parameters for predicting coronary artery disease. RESULTS: The areas under the receiver operating characteristic curve between coronary artery disease and low likelihood of coronary artery disease groups for the QRS score and ΔSTV5, ΔQaVF, and ΔRaVF were 0.75, 0.73, 0.71, and 0.71, respectively. These areas were lower (0.62, 0.57, 0.60, and 0.60, respectively) between the groups with and without angiographically proven coronary artery disease. QRS score demonstrated the highest sensitivity at 80% specificity (61.5%) and the highest specificity at 80% sensitivity (57.6%). CONCLUSIONS: This study suggests that the QRS and ST-segment depression have a moderate diagnostic ability to predict coronary artery disease in women. Q and R waves in lead aVF showed good diagnostic ability.
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Beyene et al. (2022) conducted an observational in Coronary artery disease (n=332). QRS score vs. Conventional ST-segment depression (ΔSTV5) was evaluated on Area under the receiver operating characteristic curve (AUC) for diagnosing coronary artery disease compared to low likelihood of disease (AUC 0.75, p=<0.001). The exercise-induced QRS score demonstrated moderate diagnostic ability for predicting coronary artery disease in women with an AUC of 0.75, which was not significantly different from conventional ST-segment depression.
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