Document Detail

The accuracy of the electrocardiogram during exercise stress test based on heart size.
MedLine Citation:
PMID:  21857990     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Multiple studies have shown that the exercise electrocardiogram (ECG) is less accurate for predicting ischemia, especially in women, and there is additional evidence to suggest that heart size may affect its diagnostic accuracy.
HYPOTHESIS: The purpose of this investigation was to assess the diagnostic accuracy of the exercise ECG based on heart size.
METHODS: We evaluated 1,011 consecutive patients who were referred for an exercise nuclear stress test. Patients were divided into two groups: small heart size defined as left ventricular end diastolic volume (LVEDV) <65 mL (Group A) and normal heart size defined as LVEDV ≥65 mL (Group B) and associations between ECG outcome (false positive vs. no false positive) and heart size (small vs. normal) were analyzed using the Chi square test for independence, with a Yates continuity correction. LVEDV calculations were performed via a computer-processing algorithm. SPECT myocardial perfusion imaging was used as the gold standard for the presence of coronary artery disease (CAD).
RESULTS: Small heart size was found in 142 patients, 123 female and 19 male patients. There was a significant association between ECG outcome and heart size (χ(2) = 4.7, p = 0.03), where smaller hearts were associated with a significantly greater number of false positives.
CONCLUSIONS: This study suggests a possible explanation for the poor diagnostic accuracy of exercise stress testing, especially in women, as the overwhelming majority of patients with small heart size were women.
Jason C Siegler; Shafiq Rehman; Geetha P Bhumireddy; Raushan Abdula; Igor Klem; Sorin J Brener; Leonard Lee; Christopher C Dunbar; Barry Saul; Terrence J Sacchi; John F Heitner
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-08-17
Journal Detail:
Title:  PloS one     Volume:  6     ISSN:  1932-6203     ISO Abbreviation:  PLoS ONE     Publication Date:  2011  
Date Detail:
Created Date:  2011-08-22     Completed Date:  2012-02-15     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  101285081     Medline TA:  PLoS One     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e23044     Citation Subset:  IM    
Department of Sport, Health & Exercise Science, University of Hull, Hull, United Kingdom.
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MeSH Terms
Coronary Artery Disease / diagnosis,  physiopathology
Electrocardiography / standards*
Exercise Test*
Heart / physiopathology*,  radionuclide imaging
Middle Aged
Myocardial Perfusion Imaging / methods
Myocardium / pathology*
Organ Size
Reproducibility of Results
Sensitivity and Specificity
Thallium Radioisotopes / diagnostic use
Tomography, Emission-Computed, Single-Photon / methods
Reg. No./Substance:
0/Thallium Radioisotopes

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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