Temporal electrical heterogeneity for detecting coronary artery disease: results in a heterogeneous cardiac population

BACKGROUND A new 22-lead electrocardiographic test has been advocated as a screening tool for coronary artery disease and has been shown to have accuracy similar to stress elctrocardiography in specific patient populations.

OBJECTIVE To determine the accuracy of this test for detecting coronary artery disease in patients undergoing coronary angiography for a variety of cardiac conditions.

METHODS We prospectively determined the temporal electrical heterogeneity (TEH) index at rest in 70 patients who had no angina or Q waves on the resting 12-lead electrocardiogram before they underwent coronary angiography.

RESULTS Twenty-six of the 70 patients had significant coronary artery disease, defined as 70% stenosis or greater in at least one major epicardial coronary artery. A TEH index of 80 or more had a sensitivity of 58%, a specificity of 75%, and a positive predictive value of 58%. The group with significant coronary disease had a mean TEH index of 77.2, and the group without coronary disease had a mean index of 65.5 (P = .02), despite similar clinical characteristics and indications for angiography.

CONCLUSION The TEH index shows promise as a screening tool for coronary artery disease in a heterogeneous cardiac population. However, larger studies are needed before it can be endorsed for widespread clinical use.