Quantitative and Qualitative Analysis of the Relationship between Exercise-induced R Wave Amplitude Changes and Severity of Coronary Artery Disease

L. de CAPRIO; C. VIGORITO; S. CUOMO; D. VITALE; A.M.F. ZARRA; G. CASULLO; F. RENGO

doi:10.1536/ihj.25.923

L. de CAPRIO, C. VIGORITO, S. CUOMO, D. VITALE, A.M.F. ZARRA, G. CASULLO, F. RENGO

Author information

JOURNAL FREE ACCESS

1984 Volume 25 Issue 6 Pages 923-935

DOI https://doi.org/10.1536/ihj.25.923

Details

Published: 1984 Received: May 12, 1983 Available on J-STAGE: December 09, 2008 Accepted: - Advance online publication: - Revised: -
Correction information
Date of correction: December 09, 2008 Reason for correction: - Correction: ABSTRACT Details: Wrong : The correlation between R wave voltage variations (ΔR) and the angiographic severity of coronary artery disease (CAD) at progressively increasing heart rate (HR) steps was evaluated in 51 patients (pts) without CAD (OV), in 42 pts with single (SVD), in 43 with double (DVD) and in 59 pts with triple vessel disease (TVD).
At the end of stress the sensitivity of ΔR was higher in DVD and TVD pts than in SVD pts. There was no clear correlation between exercise-induced R wave changes and the angiographic severity of CAD, since the qualitative and quantitative ΔR evaluation during effort showed similar changes in ΔR for a wide range of HR's in the entire study population.
Since different degrees of exercise tolerance were found in pts with SVD, DVD and TVD, we hypothesize that the correlation between ΔR and the severity of CAD at the end of stress testing may be artifactual.
Right : The correlation between R wave voltage variations (ΔR) and the angiographic severity of coronary artery disease (CAD) at progressively increasing heart rate (HR) steps was evaluated in 51 patients (pts) without CAD (OV), in 42 pts with single (SVD), in 43 with double (DVD) and in 59 pts with triple vessel disease (TVD).
At the end of stress the sensitivity of ΔR was higher in DVD and TVD pts than in SVD pts. There was no clear correlation between exercise-induced R wave changes and the angiographic severity of CAD, since the qualitative and quantitative ΔR evaluation during effort showed similar changes in ΔR for a wide range of HR's in the entire study population.
Since different degrees of exercise tolerance were found in pts with SVD, DVD and TVD, we hypothesize that the correlation between ΔR and the severity of CAD at the end of stress testing may be artifactual.

Date of correction: December 09, 2008 Reason for correction: - Correction: AFFILIATION Details: Wrong :
1) I^o Cattedra di Medicina Interna, 2^A Facoltà di Medicina e Chirurgia, Universita degli Studi di Napoli

Right :
1) the I°Cattedra di Medicina Interna, 2^A Facoltà di Medicina e Chirurgia, Universita degli Studi di Napoli

Date of correction: December 09, 2008 Reason for correction: - Correction: CITATION Details: Wrong : 1. Bonoris PE, Greenberg PS, Christinson GW, Castellanet MJ, Ellestad MH: Evaluation of R wave amplitude changes versus ST segment depression in stress testing. Circulation 57: 904,1978
2. Yannikas J, Marcomichelakis J, Tappurt P, Kelly BH, Emanuel R: Analysis of exercise-induced changes in R wave amplitude in asymptomatic men with electrocardiographic ST-T changes at rest. Am J Cardiol 47: 238, 1981
3. deCaprio L, Cuomo S, Bellotti P, Adamo B, Postiglione M, Vigorito C, Rengo F: R wave amplitude changes during stress testing. Comparison with ST segment depression and angiographic correlation. Am Heart J 99: 413, 1980
4. Gillespie JA, Bodenheimer MM, Fouche CM, Banka VS, Helfant RH: Limitations in the use of changes in R wave amplitude with stress test electrocardiogram to improve detection of coronary heart disease (abstr). Circulation 58 (Suppl II): II-199, 1978
5. Wagner S, Cohn K, Selzer A: Unreliability of exercise-induced R wave changes as index of coronary artery disease. Am J Cardiol 44: 1241, 1979
6. Rowe DH, Autry A, De Castro CM, Garcia E, Hall RJ: The value of electrocardiographic R wave changes in exercise testing. Pre-exercise versus post-exercise measurements. Cardiovasc Dis 8: 333, 1981
7. Fox K, England D, Jonathan A, Selwin A: Inability of exercise-induced R wave changes to predict coronary artery disease. Am J Cardiol 49: 674, 1982
8. deCaprio L, Cuomo S, Vigorito C, Meccariello P, Romano M, Zarra A, Rengo F: Influence of heart rate on exercise-induced R wave amplitude changes. Am Heart J 107: 61, 1984
9. Bonoris PE, Greenberg PS, Castellanet MJ, Ellestad MH: Significance of changes in R wave amplitude during treadmill stress testing. Angiographic correlation. Am Heart J 99: 413, 1980
10. Greenberg PS, Ellestad MH, Berge R, Johnson K, Hayes M, Bible M, Morales-Ballejo H: Radionuclide angiographic correlation of the R wave, ejection fraction and volume responses to upright bicycle exercise. Chest 80: 459, 1981
11. Berman JL, Wynne J, Cohn PF: Multiple-lead QRS changes with exercise testing. Diagnostic value and hemodynamic implications. Circulation 61: 53, 1980
12. Baron DW, Ilsely C, Shieban I, Poole-Wilson PA, Richards AF: R wave amplitude during exercise; relation to left ventricular function and coronary artery disease. Br Heart J 44: 512, 1980
13. Bonoris P, Toutouzas P, Papadopoulos P, Zacharoulis A, Augoustakis D: Correlation of R wave amplitude and left ventricular end-diastolic pressure changes during effort (abstr). Abstract Book Vol 1, No 0710, 9th World Congress of Cardiology, Moscow, June 20-26, 1982
14. Sones FM Jr, Shirey EK: Cinecoronary arteriography. Mod Concepts Cardiovasc Dis 31: 735, 1962
15. Ellestad MH: Stress Test Principles and Practice, FA Davis Co, Philadelphia, p 67-84, 1975
16. Brownlee KA: Statistical Theory and Methodology in Science and Engineering, John Wiley & Sons Inc, New York, 1974
17. Battler A, Froelicher V, Slutsky R, Ashburn W: Relationship of QRS amplitude changes during exercise to left ventricular function and volumes and the diagnosis of coronary artery disease. Circulation 60: 1004, 1979
18. Froelicher VF, Wolthuis RA, Eischer J, Uhl G: Variations in normal electrocardiographic response to treadmill exercise testing. Circulation 60: 1028, 1979
19. Brody DA: A theoretical analysis of intracavitary blood mass influence on the heart lead relationship. Circulat Res 4: 731, 1956
20. Vine DL, Finchum RL, Dodge HT, Bancroft WH Jr, Hurst DC: Comparison of the vectorcardiogram with the electrocardiogram in the prediction of left ventricular size. Circulation 43: 547, 1971
21. Baxley WA, Dodge HT, Sandler H: A quantitative angiocardiographic study of left ventricular hypertrophy and the electrocardiogram. Circulation 37: 509, 1968
22. Bayley RH, Kalbleisch JM, Berry PM: Changes in the body's surface potentials produced by alterations in certain compartments of the non homogenous conducting model. Am Heart J 77: 517, 1969
23. Levken J, Chatterjee K, Tyberg J, Stowa DF, Mathey DG, Parmeley WW: Pronounced dependence of ventricular endocardial QRS potentials on ventricular volume. Br Heart J 40: 891, 1978
24. Talbot S, Kirkpatrik D, Johnathan A, Raphael MJ: QRS voltage of the electrocardiogram and Frank vectorcardiogram in relation to ventricular volume. Br Heart J 39: 1109, 1977
25. Cuomo S, Vigorito C, deCaprio L, Maione S, Giunta A, Serino C, Romano M, Rengo F: Influenza delle variazioni del volume ventricolare sinistro indotte dalla manovra di Valsalva sull'ampiezza dell'onda R. Giorn It Cardiol 11: 903, 1981
26. Ishikawa K, Berson AS, Pipberger HV: Electrocardiographic changes due to cardiac enlargement. Am Heart J 81: 635, 1971
27. Rerych SK, Scholz PM, Newman GE, Sabiston DC, Jones RH: Cardiac function at rest and during exercise in normals and in patients with coronary heart disease. Evaluation by radionuclide angiocardiography. Ann Surg 197: 443, 1978
28. Stein RA, Nitchelli D, Fox L, Krasnow N: Continuous ventricular dimensions in man during supine exercise and recovery. An echocardiographic study. Am J Cardiol 41: 655, 1978
29. Slutsky R: Response of the left ventricle to stress. Effects of exercise atrial pacing, afterload stress and drugs. Am J Cardiol 47: 357, 1981
30. Iskandrian AS, Hakki AH, Kane SA, Segal BL: Quantitative radionuclide angiography in assessment of hemodynamic changes during upright exercise. Observations in normal subjects, patients with coronary artery disease and patients with aortic regurgitation. Am J Cardiol 48: 239, 1981
31. Bruce RA, Li YB, Dower GE, Nilson K: Polarcardiographic responses to maximal exercise and to changes in posture in healthy middle-aged man. J Electrocardiol 6: 91, 1973
32. Kentala E, Luurila O: Response of R wave amplitude to postural changes and to exercise. A study on healty subjects and patients surviving acute myocardial infarction. Ann Clin Res 7: 258, 1975
33. David D, Naito M, Chen C, Morganroth J, Shaffenburg M: R wave amplitude variations during acute myocardial ischemia: an inadequate index for changes in intracardiac volume. Circulation 63: 1364, 1981
34. David D, Naito M, Michelson E, Watanabe Y, Chen CC, Morganroth J, Shaffenburg M, Blenko T: Intramyocardial conduction: a major determinant of R-wave amplitude during acute myocardial ischemia. Circulation 65: 161, 1982
35. De Lanne R, Barnes JR, Brohua L: Hematological changes during muscular activity and recovery. J Appl Physiol 15: 31, 1960
36. Lepeschkin E: Physiological factors influencing the electrocardiographic response to exercise. in Measurements in Exercise Electrocardiography, ed by Blackburn H, The Ernest Simonson Conference, CC Thomas, Springfield, ILL, p 363, 1969
37. Holland PR, Brooks H: The QRS complex during myocardial ischemia. An experimental analysis in the porcine heart. J Clin Invest 57: 541, 1976
38. Carbonin PU, Di Gennaro M, Valle R, Bernabei R, Habed A: Intracellular calcium and electrocardiogram in ischemic isolated rat heart. Am J Physiol 239 (Heart Circulat Physiol): H 380, 1980

Right : 1. Bonoris PE, Greenberg PS, Christinson GW, Castellanet MJ, Ellestad MH: Evaluation of R wave amplitude changes versus ST segment depression in stress testing. Circulation 57: 904, 1978
2. Yannikas J, Marcomichelakis J, Tappurt P, Kelly BH, Emanuel R: Analysis of exercise-induced changes in R wave amplitude in asymptomatic men with electrocardiographic ST-T changes at rest. Am J Cardiol 47: 238, 1981
3. deCaprio L, Cuomo S, Bellotti P, Adamo B, Postiglione M, Vigorito C, Rengo F: R wave amplitude changes during stress testing. Comparison with ST segment depression and angiographic correlation. Am Heart J 99: 413, 1980
4. Gillespie JA, Bodenheimer MM, Fouche CM, Banka VS, Helfant RH: Limitations in the use of changes in R wave amplitude with stress test electrocardiogram to improve detection of coronary heart disease (abstr). Circulation 58 (Suppl II): II-199, 1978
5. Wagner S, Cohn K, Selzer A: Unreliability of exercise-induced R wave changes as index of coronary artery disease. Am J Cardiol 44: 1241, 1979
6. Rowe DH, Autry A, De Castro CM, Garcia E, Hall RJ: The value of electrocardiographic R wave changes in exercise testing. Pre-exercise versus post-exercise measurements. Cardiovasc Dis 8: 333, 1981
7. Fox K, England D, Jonathan A, Selwin A: Inability of exercise-induced R wave changes to predict coronary artery disease. Am J Cardiol 49: 674, 1982
8. deCaprio L, Cuomo S, Vigorito C, Meccariello P, Romano M, Zarra A, Rengo F: Influence of heart rate on exercise-induced R wave amplitude changes. Am Heart J 107: 61, 1984
9. Bonoris PE, Greenberg PS, Castellanet MJ, Ellestad MH: Significance of changes in R wave amplitude during treadmill stress testing. Angiographic correlation. Am Heart J 99: 413, 1980
10. Greenberg PS, Ellestad MH, Berge R, Johnson K, Hayes M, Bible M, Morales-Ballejo H: Radionuclide angiographic correlation of the R wave, ejection fraction and volume responses to upright bicycle exercise. Chest 80: 459, 1981
11. Berman JL, Wynne J, Cohn PF: Multiple-lead QRS changes with exercise testing. Diagnostic value and hemodynamic implications. Circulation 61: 53, 1980
12. Baron DW, Ilsely C, Shieban I, Poole-Wilson PA, Richards AF: R wave amplitude during exercise; relation to left ventricular function and coronary artery disease. Br Heart J 44: 512, 1980
13. Bonoris P, Toutouzas P, Papadopoulos P, Zacharoulis A, Augoustakis D: Correlation of R wave amplitude and left ventricular end-diastolic pressure changes during effort (abstr). Abstract Book Vol 1, No 0710, 9th World Congress of Cardiology, Moscow, June 20-26, 1982
14. Sones FM Jr, Shirey EK: Cinecoronary arteriography. Mod Concepts Cardiovasc Dis 31: 735, 1962
15. Ellestad MH: Stress Test Principles and Practice, FA Davis Co, Philadelphia, p 67-84, 1975
16. Brownlee KA: Statistical Theory and Methodology in Science and Engineering, John Wiley & Sons Inc, New York, 1974
17. Battler A, Froelicher V, Slutsky R, Ashburn W: Relationship of QRS amplitude changes during exercise to left ventricular function and volumes and the diagnosis of coronary artery disease. Circulation 60: 1004, 1979
18. Froelicher VF, Wolthuis RA, Eischer J, Uhl G: Variations in normal electrocardiographic response to treadmill exercise testing. Circulation 60: 1028, 1979
19. Brody DA: A theoretical analysis of intracavitary blood mass influence on the heart lead relationship. Circulat Res 4: 731, 1956
20. Vine DL, Finchum RL, Dodge HT, Bancroft WH Jr, Hurst DC: Comparison of the vectorcardiogram with the electrocardiogram in the prediction of left ventricular size. Circulation 43: 547, 1971
21. Baxley WA, Dodge HT, Sandler H: A quantitative angiocardiographic study of left ventricular hypertrophy and the electrocardiogram. Circulation 37: 509, 1968
22. Bayley RH, Kalbleisch JM, Berry PM: Changes in the body's surface potentials produced by alterations in certain compartments of the non homogenous conducting model. Am Heart J 77: 517, 1969
23. Levken J, Chatterjee K, Tyberg J, Stowa DF, Mathey DG, Parmeley WW: Pronounced dependence of ventricular endocardial QRS potentials on ventricular volume. Br Heart J 40: 891, 1978
24. Talbot S, Kirkpatrik D, Johnathan A, Raphael MJ: QRS voltage of the electrocardiogram and Frank vectorcardiogram in relation to ventricular volume. Br Heart J 39: 1109, 1977
25. Cuomo S, Vigorito C, deCaprio L, Maione S, Giunta A, Serino C, Romano M, Rengo F: Influenza delle variazioni del volume ventricolare sinistro indotte dalla manovra di Valsalva sull'ampiezza dell'onda R. Giorn It Cardiol 11: 903, 1981
26. Ishikawa K, Berson AS, Pipberger HV: Electrocardiographic changes due to cardiac enlargement. Am Heart J 81: 635, 1971
27. Rerych SK, Scholz PM, Newman GE, Sabiston DC, Jones RH: Cardiac function at rest and during exercise in normals and in patients with coronary heart disease. Evaluation by radionuclide angiocardiography. Ann Surg 197: 443, 1978
28. Stein RA, Nitchelli D, Fox L, Krasnow N: Continuous ventricular dimensions in man during supine exercise and recovery. An echocardiographic study. Am J Cardiol 41: 655, 1978
29. Slutsky R: Response of the left ventricle to stress. Effects of exercise atrial pacing, afterload stress and drugs. Am J Cardiol 47: 357, 1981
30. Iskandrian AS, Hakki AH, Kane SA, Segal BL: Quantitative radionuclide angiography in assessment of hemodynamic changes during upright exercise. Observations in normal subjects, patients with coronary artery disease and patients with aortic regurgitation. Am J Cardiol 48: 239, 1981
31. Bruce RA, Li YB, Dower GE, Nilson K: Polarcardiographic responses to maximal exercise and to changes in posture in healthy middle-aged man. J Electrocardiol 6: 91, 1973
32. Kentala E, Luurila O: Response of R wave amplitude to postural changes and to exercise. A study on healty subjects and patients surviving acute myocardial infarction. Ann Clin Res 7: 258, 1975
33. David D, Naito M, Chen C, Morganroth J, Shaffenburg M: R wave amplitude variations during acute myocardial ischemia: an inadequate index for changes in intracardiac volume. Circulation 63: 1364, 1981
34. David D, Naito M, Michelson E, Watanabe Y, Chen CC, Morganroth J, Shaffenburg M, Blenko T: Intramyocardial conduction: a major determinant of R-wave amplitude during acute myocardial ischemia. Circulation 65: 161, 1982
35. De Lanne R, Barnes JR, Brohua L: Hematological changes during muscular activity and recovery. J Appl Physiol 15: 31, 1960
36. Lepeschkin E: Physiological factors influencing the electrocardiographic response to exercise. in Measurements in Exercise Electrocardiography, ed by Blackburn H, The Ernest Simonson Conference, CC Thomas, Springfield, ILL, p 363, 1969
37. Holland PR, Brooks H: The QRS complex during myocardial ischemia. An experimental analysis in the porcine heart. J Clin Invest 57: 541, 1976
38. Carbonin PU, Di Gennaro M, Valle R, Bernabei R, Habed A: Intracellular calcium and electrocardiogram in ischemic isolated rat heart. Am J Physiol 239 (Heart Circulat Physiol): H 380, 1980

Date of correction: December 09, 2008 Reason for correction: - Correction: PDF FILE Details: -

Abstract

The correlation between R wave voltage variations (ΔR) and the angiographic severity of coronary artery disease (CAD) at progressively increasing heart rate (HR) steps was evaluated in 51 patients (pts) without CAD (OV), in 42 pts with single (SVD), in 43 with double (DVD) and in 59 pts with triple vessel disease (TVD).
At the end of stress the sensitivity of ΔR was higher in DVD and TVD pts than in SVD pts. There was no clear correlation between exercise-induced R wave changes and the angiographic severity of CAD, since the qualitative and quantitative ΔR evaluation during effort showed similar changes in ΔR for a wide range of HR's in the entire study population.
Since different degrees of exercise tolerance were found in pts with SVD, DVD and TVD, we hypothesize that the correlation between ΔR and the severity of CAD at the end of stress testing may be artifactual.

Correction information

Register with J-STAGE for free!