Escore Eletrocardiográfico: Aplicação em Ergometria para Avaliação do Precondicionamento Isquêmico Electrocardiographic Score: Application in Exercise Test for the Assessment of Ischemic Preconditioning

The time for 1.0 mm ST-segment depression (T-1.0mm) adopted to characterize ischemic preconditioning (IPC) in sequential exercise tests is consistent and reproducible; however, it has several limitations. Objective: To apply an electrocardiographic score of myocardial ischemia in sequential exercise tests, comparing it to the conventional T-1.0 mm index. Methods: Sixty one patients with mean age of 62.2 ± 7.5 years were evaluated; 86.9% were males. A total of 151 tests were analyzed, 116 of which were from patients who completed two assessment phases. The first phase comprised two sequential exercise tests for the documentation of IPC; the second phase, initiated one week later, comprised two more tests carried out under the effect of repaglinide. Two observers who were blind to the tests applied the score. Results: Perfect inter and intraobserver agreement was found (Kendall tau-b = 0.96, p < 0.0001, and Kendall tau-b = 0.98, p < 0.0001, respectively). Values of sensitivity and specificity, negative predictive value, positive predictive value and accuracy were 72.41%, 89.29%, 75.8%, 87.5% and 81.0%, respectively. Conclusion: The ischemic score is a consistent and reproducible method for the documentation of IPC, and is a feasible alternative to T-1.0 mm. (Arq Bras Cardiol 2010; 95(4): 486-492)