[High-fidelity spectrocardiography for the diagnosis of ischemic cardiopathy. The validation of a new method for analyzing the spectral components of the QRS complex].
BACKGROUND
Analysis of high-frequency QRS complex envelope has been suggested as a method that could detect myocardial ischemia but the characteristics of the turbulence spectral from an spectral-temporal mapping into the QRS complex has not been studied yet. This is a prospective study of phase I for the validation of a new diagnostic test.


OBJECTIVE
The aims for this study are: 1) To validate a new method for the detection of transient myocardial ischemia by both, high-frequency QRS and spectral turbulence analysis, which we have named "high-fidelity spectrocardiogram" (HFS). 2) To compare the sensitivity, specificity and accuracy of this HFS versus those obtained from nuclear medicine (NM-MIBI) and a conventional exercise ECG test, in a highly selected population.


METHODS
Twenty-five patients (P) were studied: 10 P (Group B) with risk factors for coronary artery disease, without previous infarct, who had atypical precordial pain and a conventional ECG considered as "normal" by two cardiologists. The group A was formed by 15 P without risk factors or another kind of heart disease. All patients underwent a conventional surface ECG, which had to be normal in order to be considered for this study. Echocardiogram, exercise testing ECG and a NM-MIBI study were also normal. The HFS recording was taken before and after Dipyridamole testing, similar to the conventional method for the NM-MIBI (dipyridamole 0.25 mg/Kg/doses) studies. Our software for the analysis of QRS-frequencies was constructed from a language Turbo C++. The Fourier's transform allowed the construction of 3-dimensional graphics. After the determination of the best wide band for detecting changes in the frequency contained of QRS, the determination coefficients (r2) were obtained and compared before and after the challenge with dipyridamole. These changes were compared between groups (A vs B) later.


RESULTS
The r2 changed more than 30% after dipyridamole in those patients in whom myocardial ischemia was demonstrated later by NM-MIBI. The sensitivity (85%) and specificity (90%) of HFS were similar to the nuclear medicine for identifying myocardial ischemia, but higher than a conventional exercise ECG testing (p.001). The main change in HFS was in the frequency-contained QRS in the 130-260 Hz band. The accuracy of our method was increased when an analysis of each orthogonal lead was made. There was a clear tendency of the group B to increase the QRS duration, while the contrary was found in group A, being the QRS the shorter (p.064). The chronological responses were different in those patients with ischemia.


CONCLUSIONS
This study suggests that an episode of myocardial ischemia is able to change in a dramatic manner the frequency-contained within of the QRS complex, in spite of an unchanged ST segment in the conventional exercise ECG. We suggest that the HFS could be a good method for identifying myocardial ischemia. Its advantages could be important, particularly when the conventional exercise ECG is non informative.
Rosas Peralta
M
M
Departamento de Cardiología Clínica 3a, Instituto Nacional de Cardiología Ignacio Chávez, México, D.F.
Infante
O
O
González Hermosillo
J A
JA
de Micheli
A
A
Kuri Alfaro
J
J
Alexánderson Rosas
E
E
Cárdenas Loaeza
M
M
D000368:Aged; D004176:Dipyridamole; D004562:Electrocardiography / Q000187:drug effects / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D005583:Fourier Analysis; D006801:Humans; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis*; D011446:Prospective Studies; D012016:Reference Values; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted / Q000295:instrumentation; D014665:Vasodilator Agents
D014665:Vasodilator Agents; D004176:Dipyridamole
Espectrocardiografía de alta fidelidad para el diagnóstico de cardiopatía isquémica. Validación de un nuevo método para el análisis de los componentes espectrales del complejo QRS.