Detection of stress-induced myocardial ischemia from the depolarization phase of the cardiac cycle-a preliminary study

Eran Toledo*, Jonathan A. Lipton, Stafford G. Warren, Shimon Abboud, Mike Broce, Donald R. Lilly, Charles Maynard, B. Daniel Lucas, Galen S. Wagner

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Electrocardiogram (ECG)-based detection of ischemia is typically dependent on identifying changes in repolarization. Analysis of high-frequency QRS (HFQRS) components, related to the depolarization phase of the cardiac action potential, has been reported to better identify ischemia. Our aim was to test the hypothesis that HFQRS analysis is both more sensitive and specific than standard ECG for detecting exercise-induced ischemia in patients undergoing exercise myocardial perfusion imaging (MPI). Methods: Exercise MPI was performed in 133 consecutive patients (age, 63 ± 12; 100 males) and used as the gold standard for ischemia. Patients with QRS duration more than 120 milliseconds (n = 20), technical problems (n = 8), or inconclusive MPI (n = 4) were excluded, leaving 101 patients for analysis. Conventional ECG was combined with high-resolution ECG acquisition that was digitized and analyzed using the HyperQ System (BSP, Tel Aviv, Israel). The relative HFQRS intensity change during exercise was used as an index of ischemia. Results: Of the 101 patients who were included in the analysis, 19 exhibited MPI ischemia. The HFQRS index of ischemia was found to be more sensitive (79% vs 41%; P < .05) and more specific (71% vs 57%; P < .05) than conventional ST analysis. Conclusions: The HFQRS analysis was more sensitive and specific than conventional ECG interpretation in detecting exercise-induced ischemia and exhibited enhanced diagnostic performance in both women and men. Thus, it may aid in the noninvasive diagnosis of ischemic heart disease.

Original languageEnglish
Pages (from-to)240-247
Number of pages8
JournalJournal of Electrocardiology
Issue number3
StatePublished - May 2009


  • Exercise test
  • High-frequency ECG
  • Ischemia
  • Ischemic heart disease


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