Exercise high-frequency QRS versus exercise stress electrocardiography in diagnosing myocardial ischemia: A meta-analysis

Abstract

Background and objects

Exercise stress high-frequency QRS (ES-HFQRS) is a new non-invasive diagnostic technique mainly for myocardial ischemia, which has been demonstrated with favorable diagnostic efficacy in patients with early ischemic symptoms. Multiple studies confirmed ES-HFQRS's superior diagnostic performance over traditional exercise stress electrocardiography (EST) analysis. However, until now, there is still no meta-analysis that compares the diagnostic efficacy of ES-HFQRS and EST.Therefore, this meta aims to compare the diagnostic value of ES-HFQRS with EST.

Methods

Databases were searched up to August 4, 2025, using keywords including “exercise stress HFQRS” and “exercise stress electrocardiography”. Sensitivity and specificity were pooled using a bivariate random-effects model. Summary receiver operating characteristic (SROC) curves were plotted, and the area under the curve (AUC) was calculated. Subgroup analyses and Meta-regression explored sources of heterogeneity.

Results

Ten studies involving 3352 patients were included. The pooled sensitivity of ES-HFQRS was significantly higher than that of EST (65% [95% CI: 55%–73%] vs. 37% [95% CI: 29%–45%]; P < 0.001), with no significant difference in specificity (78% [95% CI: 72%–83%] for HFQRS vs. 85% [95% CI: 78%–90%] for EST; P = 0.12). The AUCs of ES-HFQRS and EST were 0.77 and 0.64, respectively. Parallel test combining both methods achieved significantly higher sensitivity than EST alone (76% [95% CI: 69%–82%] vs. 37% [95% CI: 29%–45%]; P < 0.001) while maintaining stable specificity at 64% (95% CI: 58%–70%). The serial test increased specificity to 96% (95% CI: 94%–97%),with a significantly lower sensitivity of 22% (95% CI: 17%–29%).

Conclusion

ES-HFQRS had superior sensitivity to EST for the non-invasive diagnosis of myocardial ischemia. Combining both analytical methods flexibly could enhance the diagnostic value in the detection of myocardial ischemia.