Rajesh Pradhan1, Ashok Chaudhary, Anthony A Donato. 1. Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. rajesh.pradhan@jeffersonhospital.org
Abstract
BACKGROUND: Rapid atrial fibrillation (AF) is commonly associated with ST-segment depressions. ST-segment depression during a chest pain episode or exercise stress testing in sinus rhythm is predictive of obstructive coronary artery disease (CAD), but it is unclear if the presence or magnitude of ST-segment depression during rapid AF has similar predictive accuracy. METHODS: One hundred twenty-seven patients with rapid AF (heart rate ≥120 beats per minute) who had cardiac catheterization performed during the same hospital admission were retrospectively reviewed. Variables to compute thrombolysis in myocardial infarction (TIMI) risk score, demographic profiles, ST-segment deviation, cardiac catheterization results, and cardiac interventions were collected. RESULTS: Thirty-five patients had ST-segment depression of 1 mm or more, and 92 had no or less than 1 mm ST depression. Thirty-one patients were found to have obstructive CAD. In the group with ST-segment depression, 11 (31%) patients had obstructive CAD and 24 (69%) did not. In the group with less than 1 mm ST-segment depression, 20 (22%) had obstructive CAD and 72 (78%) did not (P = .25). Sensitivity, specificity, and positive and negative predictive values for presence of obstructive CAD were 35%, 75%, 31%, and 78%, respectively. The presence of ST-segment depression of 1 mm or more was not associated with presence of obstructive CAD before or after adjustment of TIMI variables. The relationship between increasing grades of ST-segment depression and obstructive CAD showed a trend toward significance (P = .09), which did not persist after adjusting for TIMI risk variables (P = .36). CONCLUSION: ST-segment depression during rapid AF is not predictive for the presence of obstructive CAD.
BACKGROUND: Rapid atrial fibrillation (AF) is commonly associated with ST-segment depressions. ST-segment depression during a chest pain episode or exercise stress testing in sinus rhythm is predictive of obstructive coronary artery disease (CAD), but it is unclear if the presence or magnitude of ST-segment depression during rapid AF has similar predictive accuracy. METHODS: One hundred twenty-seven patients with rapid AF (heart rate ≥120 beats per minute) who had cardiac catheterization performed during the same hospital admission were retrospectively reviewed. Variables to compute thrombolysis in myocardial infarction (TIMI) risk score, demographic profiles, ST-segment deviation, cardiac catheterization results, and cardiac interventions were collected. RESULTS: Thirty-five patients had ST-segment depression of 1 mm or more, and 92 had no or less than 1 mm ST depression. Thirty-one patients were found to have obstructive CAD. In the group with ST-segment depression, 11 (31%) patients had obstructive CAD and 24 (69%) did not. In the group with less than 1 mm ST-segment depression, 20 (22%) had obstructive CAD and 72 (78%) did not (P = .25). Sensitivity, specificity, and positive and negative predictive values for presence of obstructive CAD were 35%, 75%, 31%, and 78%, respectively. The presence of ST-segment depression of 1 mm or more was not associated with presence of obstructive CAD before or after adjustment of TIMI variables. The relationship between increasing grades of ST-segment depression and obstructive CAD showed a trend toward significance (P = .09), which did not persist after adjusting for TIMI risk variables (P = .36). CONCLUSION:ST-segment depression during rapid AF is not predictive for the presence of obstructive CAD.
Authors: Marc Meller Søndergaard; Jonas Bille Nielsen; Rikke Nørmark Mortensen; Gunnar Gislason; Lars Køber; Freddy Lippert; Claus Graff; Stig Haunsø; Jesper Hastrup Svendsen; Kristian Hay Kragholm; Adrian Holger Pietersen; Bent Struer Lind; Søren Pihlkjær Hjortshøj; Anders Gaarsdal Holst; Johannes Jan Struijk; Christian Torp-Pedersen; Steen Møller Hansen Journal: Open Heart Date: 2019-05-21
Authors: Rohan S Wijesurendra; Alexander Liu; Francesco Notaristefano; Ntobeko A B Ntusi; Theodoros D Karamitsos; Yaver Bashir; Matthew Ginks; Kim Rajappan; Tim R Betts; Michael Jerosch-Herold; Vanessa M Ferreira; Stefan Neubauer; Barbara Casadei Journal: J Am Heart Assoc Date: 2018-08-07 Impact factor: 5.501