[Electrocardiographic score: application in exercise test for the assessment of ischemic preconditioning].
BACKGROUND
the time for 1.0 mm ST-segment depression (T-1.0mm) adopted to characterize ischemic preconditioning (IPC) in sequential exercise tests is consistent and reproducible; however, it has several limitations.


OBJECTIVE
to apply an electrocardiographic score of myocardial ischemia in sequential exercise tests, comparing it to the conventional T-1.0 mm index.


METHODS
sixty one patients with mean age of 62.2 ± 7.5 years were evaluated; 86.9% were males. A total of 151 tests were analyzed, 116 of which were from patients who completed two assessment phases. The first phase comprised two sequential exercise tests for the documentation of IPC; the second phase, initiated one week later, comprised two more tests carried out under the effect of repaglinide. Two observers who were blind to the tests applied the score.


RESULTS
Perfect inter and intraobserver agreement was found (Kendall tau-b = 0.96, p < 0.0001, and Kendall tau-b = 0.98, p < 0.0001, respectively). Values of sensitivity and specificity, negative predictive value, positive predictive value and accuracy were 72.41%, 89.29%, 75.8%, 87.5% and 81.0%, respectively.


CONCLUSIONS
the ischemic score is a consistent and reproducible method for the documentation of IPC, and is a feasible alternative to T-1.0 mm.
Uchida
Augusto
A
Instituto do Coração, HCFMUSP, São Paulo, SP, Brasil. augustohiroshi@cardiol.br
Moffa
Paulo
P
Hueb
Whady
W
Cesar
Luiz Antonio Machado
LA
Ferreira
Beatriz Moreira Ayub
BM
Ramires
Jose Antonio Franchini
JA
D002219:Carbamates; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000503:physiopathology*; D004311:Double-Blind Method; D004562:Electrocardiography / Q000379:methods* / Q000592:standards; D016552:Ergometry; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D019194:Ischemic Preconditioning; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis*; D015588:Observer Variation; D010880:Piperidines; D011237:Predictive Value of Tests
D002219:Carbamates; D007004:Hypoglycemic Agents; D010880:Piperidines; C072379:repaglinide