Background :
@EN QT dispersion (QTD : QTmax-QTmin) or Jtdispersion(JTD : JTmax-JTmin) in 12 leads ECG has been known to reflect regional variations in ventricular repolarization and has been reported to be one of the marker of regional myocardial ischemia. To
evaluate the significance of QTD or JTD of exercise ECG in diagnosis of coronary artery disease, we studied 106 patients(mean age, 56.9 years old, male 63) who were referred for the evaluation of chest pain on exertion.
@ES Method :
@EN Treadmill exercise stress test with modified Bruce protocol and coronary angiography were performed in 106 patients with chest pain on exertion. ST-segment depression by>1.0mm 0.08 second after J-point during or after exercise in exercise
test
and
>50% stanosis of epicardial artery in coronary angiogram were defined as positive. Of 106 patients. 41 had positive exercise ECG and positive coronary angiogram(true positive. TP). 20 had positive exercise ECG and negative coronary
angiogram(false
positive, FP). 20 had negative exercise ECG and positive coronary angiogram(false negative, FN), and 23 had negative exercise ECG and negative coronary angiogram(true negative. TN). QT and JT interval in 12 leads were measured at baseline and
peak
exercise and were corrected for heart rate using Bazett's formula. QTD and JTD were measured by calculating the difference between the maximum QT and mininum QT and that between maximum JT and minumum JT.
@ES Results : QTD at baseline for TP(72.8 ms) was prolonged compared to TN(52.2 ms. P<0.01), but was not different from that for FP(70.2 ms). At peak exercise. QTD for TP(81.3 msec) was significantly prolonged(P<0.01), while QTD for FP(71.2 msec)
was
not different from that for TN(56.8 msec). JTD at baseline(78.4 msec) and at peak exercise(88.2 msec) for TP were significantly prolonged compared to those for TN(55.2msec and 55.1msec P<0.01, P<0.01, respectively), but those for FP were not
prolonged(77.0msec and 79.0msec, respectively). QTD and JTD at peak exercise were more markedly prolonged in patients with severe stenosis of coronary artery(p=0.053 and p<0.05, respectively) and multivessels diseases(p<0.01, 0<0.05) than those
with
less severe disease and single vessel disease. Patients with left anterior descending artery lesion had greater QTD and JTD at peak exercise than those with other vessels lesion(p<0.01). In addition to standard criteria with ST segment
displacement
in
exercise ECG, inclusion of exercise induced QTD of more than 60msec increased the sensitivity of exercise ECG from 66.7% to 83.3%, and JTD of more than 70msec increased the specificity from 52% to 76.0%.
@ES Conclusion :
@EN Measurement of QT dispersion and JT dispersion of exercise ECG may be useful method to identify the severity of coronary artery disease and to improve diagnostic accuracy of exercise ECG in coronary artery disease.
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