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The Significance of QTpd, QRS Duration and Frontal Plane QRS Axis Changes during Exercise Treadmill Test in Patients with Coronary Artery Disease

Author: ZhanZhongQun
Tutor: LiZengGao
School: Chongqing Medical University
Course: Internal Medicine
Keywords: exercise treadmill test coronary artery disease QTpd QRS duration frontal plane QRS axis
CLC: R541.4
Type: Master's thesis
Year: 2002
Downloads: 28
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Abstract

Objective: To investigate the clinical significance of QTpd、QRS duration and frontal plane QRS axis changes during exercise treadmill test in patients with and without coronary artery disease, and evaluate their diagnostic value in coronary artery disease.Methods: 66 patients who all underwent coronary angiography and treadmill exercise test were divided into two groups: with（N=26） and without (N=40) coronary artery disease , QTpd and QRS duration were assessed during treadmill exercise test in two groups. The patients with coronary artery disease were subdivided into 3 subgroups: 8 of subgroup 1 (with left anterior descending artery lesion and/ or left circumflex artery lesion) 、6 of subgroup 2 (with right coronary artery lesion and / or left circumflex artery lesion) 、 11 of subgroup 3 (with three vessels lesions or with left anterior descending artery lesion and right coronary artery lesion). The frontal plane QRS axis was assessed during treadmill exercise test in patients without coronary artery disease and the 3 subgroups.Results: 1 before exercise , QTpd (28.73±7.95ms vs 26.38±7.99ms, p>0.05) and<WP=7>QRS duration(85.65±8.84ms vs 86.40±7.53ms, p>0.05) were no significance differences between the two groups. 2 QTpd (26.38±7.99ms vs 26.08±7.06ms, P>0.05) was no significance difference and QRS duration (86.40±7.53ms vs 77.98±7.73ms, p<0.01) was shortened after exercise in patients without coronary artery disease, but QTpd（28.73±7.95ms与52.35±17.18ms，P<0.01） and QRS duration (77.98±7.73ms vs 94.42±11.23ms, p<0.01) were prolonged in patients with coronary artery disease. 3 After exercise, no significance axis was shifted in patients without coronary artery disease (64.33±13.59 vs 64.75±14.53,p>0.05); In subgroup 1, the frontal plane QRS axis was shifted to the left (35.00±35.47 vs 5.75±39.99, p<0.01); In subgroup 2, the frontal plane QRS axis was shifted to the right (61.58±10.41 vs 77.67±13.52, p<0.01); In subgroup 3, no significance axis shift was observed (62.90±31.11 vs 49.09±53.54, p>0.05). 4 After coronary angiography data comparing with ST depression, QTpd≥40ms and the QRS duration prolongation, The sensitivity in the diagnosis of coronary artery disease was 80.8%,92.3% and 80.8%,respectively. The specificity was 72.5%, 95% and 95%, respectively. The accuracy rate was 75.8%, 93.9% and 89.4%, respectively. Conclusions: 1 QTpd and QRS duration were prolonged in patients with coronary artery disease, but QTpd was no significance difference and QRS duration was shortened after exercise in patients without coronary artery disease. 2 Exercise-induced the frontal plane QRS axis shift to the left often means the left anterior descending artery lesion. Exercise-induced the frontal plane QRS axis shift to the right often means the right coronary artery lesion. 3 After exercise, QTpd≥40ms and the QRS duration prolongation had a relative high sensitivity, but they both had a higher specificity and accuracy in diagnosis the coronary artery disease.

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CLC: > Medicine, health > Internal Medicine > Heart, blood vessels ( circulatory ) disease > Heart disease > Coronary arteries ( atherosclerosis ),heart disease (CHD)
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