Comparison of exercise electrocardiography and magnetocardiography for detection of coronary artery disease using ST-segment fluctuation score

Article type: Research Article

Authors: Shin, Eun-Seok^{a; *; 1} | Chung, Ju-Hyun^{a; 1} | Park, Seung Gu^b | Saleh, Ahmed^c | Lam, Yat-Yin^d | Bhak, Jong^{b; e} | Jung, Friedrich^f | Morita, Sumio^g | Brachmann, Johannes^c

Affiliations: [a] Department of Cardiology, Ulsan Medical Center, Ulsan Hospital, Ulsan, South Korea | [b] Korean Genomics Industrialization and Commercialization Center (KOGIC), Ulsan National Institute of Science and Technology (UNIST), Ulsan, South Korea | [c] Coburg Hospital, 2nd Medical Department, Coburg, Germany | [d] Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong | [e] Department of Biomedical Engineering, School of Life Sciences, Ulsan National Institute of Science and Technology (UNIST), Ulsan, South Korea | [f] Institute of Biomaterial Science and Berlin-Brandenburg, Center for Regenerative Therapies (BCRT), Helmholtz Zentrum Geesthacht, Teltow, Germany | [g] Department of Cardiology, Charité Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany

Correspondence: [*] Corresponding author: Eun-Seok Shin, MD, PhD, Department of Cardiology, Ulsan Medical Center, Ulsan Hospital, 13 Wolpyeong-ro 171beon-gil, Nam-gu, Ulsan, 44686, South Korea. Tel.: +82-52-250-5020; Fax: +82-52-259-5117; E-mail: sesim1989@gmail.com.

Note: [1] Drs. Shin and Chung contributed equally as first authors.

Abstract: BACKGROUND:Exercise electrocardiography (ECG) is frequently used as a diagnostic measure in patients with suspected coronary artery disease (CAD). However, it has low sensitivity for the detection of CAD. Magnetocardiography (MCG) has been proposed as an alternative tool to accurately diagnose CAD. OBJECTIVE:To date, a direct comparison of MCG to ECG has not been performed. This study sought to compare them for predicting the presence of significantly obstructive CAD. METHODS:The patients with chest pain or other symptoms suggestive of CAD were enrolled in the analysis. All the patients underwent a clinical evaluation, exercise ECG, MCG test, and coronary angiography (CA). CAD was defined as stenosis ≥70% in at least one major coronary artery on quantitative analysis of CA. RESULTS:We prospectively enrolled 202 consecutive patients who suggested CAD. The prevalence of CAD on CA was 39.1%. Sensitivity and accuracy for CAD diagnosis was higher for MCG compared with exercise ECG (sensitivities 68.4% and 40.5%, p <0.001, specificities 95.1% and 91.1%, p = 0.267, and accuracies 84.7% and 71.3%, p <0.001, respectively). There was no incremental diagnostic value of combined MCG and ECG to detect coronary artery disease (p = 0.357). CONCLUSIONS:For the patients with intermediate to high risk of CAD, MCG exercise test provides better diagnostic accuracy for the detection of relevant obstruction of the epicardial coronaries when directly compared to exercise ECG.

Keywords: Electrocardiography, magnetocardiography, diagnostic performance

DOI: 10.3233/CH-180485

Journal: Clinical Hemorheology and Microcirculation, vol. 73, no. 2, pp. 283-291, 2019