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CLINICAL STUDY: ACUTE CORONARY SYNDROMES

Changes in high-frequency QRS components are more sensitive than ST-segment deviation for detecting acute coronary artery occlusion

Jonas Pettersson, MD^*, Olle Pahlm, MD, PhD^*, Elena Carro, MSc^* , Lars Edenbrandt, MD, PhD^*, Michael Ringborn, MD^*, Leif Sörnmo, PhD, Stafford G. Warren, MD and Galen S. Wagner, MD

^* Department of Clinical Physiology, Lund University, Lund, Sweden
Signal Processing Group, Department of Applied Electronics, Lund University, Lund, Sweden
Charleston Area Medical Center, Charleston, West Virginia, USA
Duke University Medical Center, Durham, North Carolina, USA

Manuscript received April 22, 1999; revised manuscript received May 4, 2000, accepted June 28, 2000.

Reprint requests and correspondence: Dr. Jonas Pettersson, Department of Clinical Physiology, University Hospital, SE-221 85 Lund, Sweden
jonas.pettersson{at}klinfys.lu.se

OBJECTIVES

This study describes changes in high-frequency QRS components (HF-QRS) during percutaneous transluminal coronary angioplasty (PTCA) and compares the ability of these changes in HF-QRS and ST-segment deviation in the standard 12-lead electrocardiogram (ECG) to detect acute coronary artery occlusion.

BACKGROUND

Previous studies have shown decreased HF-QRS in the frequency range of 150–250 Hz during acute myocardial ischemia. It would be important to know whether the high-frequency analysis could add information to that available from the ST segments in the standard ECG.

METHODS

The study population consisted of 52 patients undergoing prolonged balloon occlusion during PTCA. Signal-averaged electrocardiograms (SAECG) were recorded prior to and during the balloon inflation. The HF-QRS were determined within a bandwidth of 150–250 Hz in the preinflation and inflation SAECGs. The ST-segment deviation during inflation was determined in the standard frequency range.

RESULTS

The sensitivity for detecting acute coronary artery occlusion was 88% using the high-frequency method. In 71% of the patients there was ST elevation during inflation. If both ST elevation and depression were considered, the sensitivity was 79%. The sensitivity was significantly higher using the high-frequency method, p < 0.002, compared with the assessment of ST elevation.

CONCLUSIONS

Acute coronary artery occlusion is detected with higher sensitivity using high-frequency QRS analysis compared with conventional assessment of ST segments. This result suggests that analysis of HF-QRS could provide an adjunctive tool with high sensitivity for detecting acute myocardial ischemia.

Abbreviations and Acronyms   ECG = electrocardiogram   HF-QRS = high-frequency QRS components   LAD = left anterior descending coronary artery   LCX = left circumflex coronary artery   PTCA = percutaneous transluminal coronary angioplasty   RCA = right coronary artery   RMS = root-mean-square   SAECG = signal-averaged electrocardiogram

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