TY - JOUR
T1 - The accuracy of the electrocardiogram during exercise stress test based on heart size
AU - Siegler, Jason C.
AU - Rehman, Shafiq
AU - Bhumireddy, Geetha P.
AU - Abdula, Raushan
AU - Klem, Igor
AU - Brener, Sorin J.
AU - Lee, Leonard
AU - Dunbar, Christopher C.
AU - Saul, Barry
AU - Sacchi, Terrence J.
AU - Heitner, John F.
PY - 2011
Y1 - 2011
N2 - 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.
AB - 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.
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U2 - 10.1371/journal.pone.0023044
DO - 10.1371/journal.pone.0023044
M3 - Article
C2 - 21857990
AN - SCOPUS:80051736314
SN - 1932-6203
VL - 6
JO - PloS one
JF - PloS one
IS - 8
M1 - e23044
ER -