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HFQRS (High Frequency QRS ) refers to the analysis of the high frequency spectral components of the QRS complex in an electrocardiogram (ECG).

ECG of a heart in normal sinus rhythm
Left: Frequency band of standard ECG components is typically 0.05-100Hz. HFQRS represents changes in the 150-250Hz band (marked in red circle). Right: Depicts the physiological basis of HFQRS

The physiological significance of the HFQRS was first described in the 1980’s.[1] Since then, it has been extensively researched and clinically validated as an important diagnostic tool for detection of stress-induced ischemia.[2] Scientific evidences indicates that identification of depolarization abnormalities, which can be quantified using analysis of HFQRS, is more accurate in detecting Myocardial Ischemia than identification according to ST segment deviations which present limited diagnostic accuracy, particularly in women.[3][4] On August 2013, the AHA included HFQRS on exercise standards for testing, pointing out that it has been found to have useful test performance for detection of CAD [5]

HFQRS Scientific background[edit]

Conventional ECG interpretation is performed by inspecting the ECG in the 0.05–100 Hz frequency band. Detection of ischemia relies upon recognition of abnormal alterations in the repolarization phase of the cardiac cycle, manifested as changes in the ST segment of the ECG. However, significant research efforts during the last decades have shown that ischemia also induces changes to the depolarization phase.[6][7][8][3] These changes can be detected by examining the 'HFQRS. These high frequency components, resulting from the fragmented waveform of electrical activation of themyocardium, can be filtered from high resolution ECG signals in the 150 to 250 Hz frequency band. As these components are very low in amplitude (measured in µV), sophisticated computer analysis is required to reliably extract them.

Clinical Data[edit]

Several studies [2][3] show that HFQRS performs significantly better than standard ST segment based analysis in detecting myocardial ischemia in stress ECG testing, both in terms of sensitivity and in specificity. HFQRS analysis performs equally well in women,[9] a population in which standard, ST segment based stress ECG analysis, is notoriously inaccurate.[10]

Economics of High Frequency QRS[edit]

Coronary artery disease (CAD) is a major healthcare problem worldwide, being the leading cause of death (more than 8 million deaths annually [11]) and imposing an enormous global economic burden.[12] In the US alone, there are 17.6 million CAD patients, and the estimated annual incidence of new and recurrent myocardial infarction is estimated to be 935,000. The estimated direct and indirect cost of CAD is $177 bilion in 2010.[13] Accurate early diagnosis of CAD plays a crucial role in improving the prognosis of patients and in reducing the long-term costs of medical treatment. The current first line diagnostic test, standard stress ECG, lacks the desired accuracy and often leads to further testing. HFQRS may be significant for insurance companies, because it can potentially save thousands of dollars per patient by reducing the number of costly imaging procedures which also unnecessarily expose the patient to radiation.[14] Patients are sometimes referred even to invasive coronary angiography as a result of false positive stress ECG and imaging tests.

References[edit]

  1. ^ V. Mor-Avi, S. Abboud, S. Akselrod. Frequency content of the QRS notching in the high fidelity canine ECG. Comp. Biomed. Res. 22: 18-25, 1989.
  2. ^ a b Sharir, T., Merzon, K., Kruchin, I., Bojko, A., Toledo, E., Asman, A. et al, Use of ECG depolarization abnormalities for detection of stress-induced ischemia as defined by myocardial perfusion imaging. Am J Cardiol. 2012;109:642–650.
  3. ^ a b c Toledo E, Lipton JA, Warren SG, et al. Detection of stress-induced myocardial ischemia from the depolarization phase of the cardiac cycle--a preliminary study. J Electrocardiol 2009; 42:240-7.
  4. ^ Gibbons RJ, Balady GJ, Bricker JT, et al. ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). J Am Coll Cardiol 2002; 40:1531-40.
  5. ^ Gerald F., Philip A., Kligfield P., et al, Exercise Standards for Testing and Training A Scientific Statement From the American Heart Association. Circulation. 2013; 128: 873-934.
  6. ^ T S. Abboud, R.J. Cohen, D. Sadeh. A spectral analysis of the high frequency QRS potentials during acute myocardial ischemia in dogs. International Journal of Cardiology, 26: 285-290, 1990.
  7. ^ A. Beker, A. Pinchas, J. Erel, S. Abboud. Spectral Analysis of High Resolution QRS Complex During Exercise Induce Ischemia. Annals of Noninvasive Electrocardiology, 1(4): 386-392, 1996.
  8. ^ JA Lipton, SG Warren, M Broce, S Abboud, A Beker, L Sornmo, DR Lilly, CC Maynard, DB Lucas, GS Wagner. High frequency QRS electrocardiogram analysis during exercise stress testing for detecting ischemia. International Journal of Cardiology 124: 198–203, 2008
  9. ^ Rosenman D, Mogilevski Y, Abboud S, Tzivoni D. Improving the Specificity of Exercise Testing in Women by High-Frequency QRS Analysis. JACC March 9, 2010; 55, 10A.
  10. ^ Kohli P. Gulati M. Exercise Stress Testing in Women: Going Back to the Basics Circulation 2010;122:2570-2580
  11. ^ GBD 2013 Mortality and Causes of Death, Collaborators (17 December 2014). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.". Lancet 385: 117–171. doi:10.1016/S0140-6736(14)61682-2. PMC 4340604. PMID 25530442.
  12. ^ McKay J, Mensah GA. The Atlas of Heart Disease and Stroke. World Health Organization, 2004.
  13. ^ Lloyd-Jones D, Adams RJ, Brown TM, et al. Heart disease and stroke statistics--2010 update: a report from the american heart association. Circulation 2010; 121:e46-e215.
  14. ^ Amit G.,Toren Y., et al . The cost-effectiveness of stress testing using high-frequency QRS analysis. Int. J. Medical Engineering and Informatics; 2013 Vol.5, No.1

Links[edit]

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