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BY-NC-ND 3.0 license Open Access Published by De Gruyter Open Access April 9, 2010

SAECG in exercise test for prediction of diabetic coronary artery disease

  • Mohammad Bigi EMAIL logo , Amir Aslani and Arsalan Aslani
From the journal Open Medicine


Signal averaged electrocardiogram (SAECG) is considered an important noninvasive indicator identifying patients at risk for ventricular arrhythmias. The aim of this study was to improve noninvasive prediction of CAD by integrating SAECG with the result of exercise tests in diabetic patients. Diabetic patients with stable angina pectoris underwent exercise testing and SAECG. Then a diagnostic score was derived that combined results of exercise testing and SAECG. A diagnostic score (0 to 2 points) was calculated by assigning 1 point for a positive exercise test result and 1 point for a positive SAECG. One hundred and seventy patients were included in the study. In patients with a score of 0, the likelihood of CAD is 18% whereas the likelihood of CAD is 95% in patients with a score of 2. Triple vessel CAD is present in 54%, 7% and only 1.5% of patients with score 2, 1 and 0 respectively. Therefore, patients with score 2 have a poor prognosis compared with score 1 or 0. A diagnostic score combining exercise testing and SAECG can distinguish patients with CAD from those without CAD with high accuracy in diabetic patients.

[1] G. Ravapati, W.S. Aronow, C. Ahn, K. Sujata, L.N. Saulle and M.B. Weiss, Association of hemoglobin A1c level with the severity of coronary artery disease in patients with diabetes mellitus. Am J Cardiol 2006; 97: 968–969 in Google Scholar

[2] G. Ndrepepa, S. Braun, J. Mehilli, N. von Beckerath, W. Vogt, A. Schomig and A. Kastrati, Plasma levels of N-terminal pro-brain natriuretic peptide in patients with coronary artery disease and relation to clinical presentation, angiographic severity, and left ventricular ejection fraction. Am J Cardiol 2005; 95: 553–557 in Google Scholar

[3] M. Weber, T. Dill, R. Arnold, M. Rau, O. Ekinci, K.D. Muller, A. Berkovitsch, V. Mitrovic and C. Hamm, N-terminal B-type natriuretic peptide predicts extent ofcoronary artery disease and ischemia in patients with stable angina pectoris. Am Heart J 2004; 148: 612–620 in Google Scholar

[4] Buxton AE, Simson MB, Falcone RA, Marchlinski FE, Doherty JU, Josephson ME. Results of signal-averaged electrocardiography and electrophysiologic study in patients with nonsustained ventricular tachycardia after healing of acute myocardial infarction. Am J Cardiol 1987; 60: 80–85 in Google Scholar

[5] Vassallo JA, Cassidy D, Simson MB, Buxton AE, Marchlinski FE, Josephson ME. Relation of late potentials to site of origin of ventricular tachycardia associated with coronary heart disease. Am J Cardiol 1985; 55: 985–989 in Google Scholar

[6] Freedman RA, Gillis AM, Keren A, Soderholm-Difatte V, Mason JW. Signal-averaged electrocardiographic late potentials in patients with ventricular fibrillation or ventricular tachycardia: correlation with clinical arrhythmia and electrophysiologic study. Am J Cardiol 1985; 55:1350–1353 in Google Scholar

[7] The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus, Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997; 20:1183–1197 10.2337/diacare.20.7.1183Search in Google Scholar

[8] E.L. Conover, Signal-averaged ECG and fast Fourier transform analysis. In: M.B. Conover, Editor, Understanding Electrocardiography (8th ed.), Mosby, St. Louis, Missouri (2003), 447–454 Search in Google Scholar

[9] G. Breithardt, M.E. Cain, N. El-Sherif, N.C. Flowers, V. Hombach, M. Janse, M.B. Simson and G. Steinbeck, Standards of analysis of late potentials using high-resolution or signal-averaged electrocardiography: a statement by a task force committee of the European Society of Cardiology, the American Heart Association, and the American College of Cardiology. J Am Coll Cardiol 1991; 17: 999–1006 in Google Scholar

[10] K.A. Gatzoulis, L.A. Carlson, B.I. Rizos, P. Gialafos, P. Toutouzas and A.L. Waldo, Time domain analysis of the signal averaged electrocardiogram in patients with a conduction defect of a bundle branch block. Eur Heart J 1995; 16: 1912–1919 10.1093/oxfordjournals.eurheartj.a060847Search in Google Scholar PubMed

[11] A.S. Manolis, J.A. Chiladakis, J.S. Malakos, V. Vassilikos, T. Maonis and C.V. Cokkinos, Abnormal signal averaged electrocardiograms in patients with incomplete right bundle branch block. Clin Cardiol 1997; 20: 17–22 in Google Scholar PubMed PubMed Central

[12] Denes P, Uretz E, Santarelli P. Determinants of arrhythmogenic ventricular activity detected on the body surface QRS in patients with coronary artery disease. Am J Cardiol 1984; 53: 1519–1523 in Google Scholar

[13] Myerburg RJ, Epstein K, Gaide MS, Wong SS, Castellanos A, Gelband H, Bassett AL. Electrophysiologic consequences of experimental acute ischemia superimposed on healed myocardial infarction in cats. Am J Cardiol 1982; 49: 323–330 in Google Scholar

[14] Myerburg RJ, Kessler KM, Castellanos A. Pathophysiology of sudden cardiac death. Pacing Clin Electrophysiol 1991; 14: 935–943 in Google Scholar

[15] Robertson WS, Feigenbaum H, Armstrong WF, Dillon JC, O’Donnell J, McHenry PW. Exercise echocardiography: a clinically practical addition in the evaluation of coronary artery disease. J Am Coll Cardiol 1983; 2: 1085–1091 in Google Scholar

[16] McPherson DD, Horacek BM, Sutherland DJ, Armstrong CS, Spencer CA, Montague TJ. Exercise electrocardiographic mapping in normal subjects. J Electrocardiol 1985; 18: 351–360 in Google Scholar

Published Online: 2010-4-9
Published in Print: 2010-6-1

© 2010 Versita Warsaw

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

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