Comparison of computer ST criteria for diagnosis of severe coronary artery disease

Ribisl, Paul M.; Liu, James H.; Mousa, Issam; Herbert, William G.; Miranda, Cres P.; Froning, Jeffrey; Froelicher, Victor F.

doi:10.1016/0002-9149(93)90509-b

Cited by 25 publications

(8 citation statements)

References 26 publications

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“…With the use of a cut off point of 0.075 mV for ST depression, horizontal or downsloping ST depression alone yielded a sensitivity of 50% and specificity of 71% for the prediction of severe disease. 32) The Athens QRS score was found to be unrelated to exercise-induced STsegment depression and its sensitivity and specificity in predicting CAD were found to be higher than the ST-segment depression ratio. 8) In this context, although the maximum ST segment ratio was found to be lower in the SCF group than in those with coronary stenosis, a similar QRS score may indicate the presence of exercise-induced ischemia in patients with SCF.…”

Section: Discussionmentioning

confidence: 95%

<b>Comparison of Exercise QRS Amplitude Changes in Patients with Slow Coronary Flow Versus Significant Coronary Stenosis</b>

et al. 2004

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SUMMARYExercise Q, R, and S wave amplitude changes, called the QRS score, have been reported to be a marker of exercise-induced myocardial ischemia. Therefore, in this study, using the exercise QRS score, we sought to determine if slow coronary flow (SCF) phenomenon is associated with the exercise-induced myocardial ischemia.This retrospective study included 23 patients evaluated for suspected coronary artery disease and found to have SCF (group I) and 19 subjects with angiographically-defined significant coronary artery stenosis (group II). All study subjects underwent treadmill exercise testing using the modified Bruce protocol. For each subject the amplitude of the Q, R, and S waves in leads aVF and V 5 was measured manually using calipers before and immediately after exercise. The QRS score was calculated by subtracting the Q, R, and S wave differences in leads aVF and V 5 .There was no difference between the two groups with respect to demographic properties. The peak heart rate achieved, baseline and peak systolic-diastolic blood pressure, exercise duration, and the metabolic equivalent values were similar in both groups. The maximum ST-segment depression ratio was significantly lower in patients with SCF than those of significant coronary stenosis (0.8 ± 0.4 vs 1.3 ± 0.5 P = 0.001, respectively). However, the exercise QRS score was found to be similar in both groups (3.3 ± 2.3 vs 2.1 ± 3.0 P = 0.2, respectively).The data suggest that SCF phenomenon may alone lead to myocardial ischemia even in the absence of obstructed major epicardial coronary arteries as detected by similar exercise QRS scores to those of significant coronary artery stenosis. (Jpn Heart J 2004; 45: 419-428)

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Section: Discussionmentioning

confidence: 95%

<b>Comparison of Exercise QRS Amplitude Changes in Patients with Slow Coronary Flow Versus Significant Coronary Stenosis</b>

et al. 2004

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“…All others were considered horizontal or downward sloping. These values were obtained after calculations of some slopes considered horizontal visually and are somewhat more conservative than those reported by some other authors (Miranda et al ., 1992; Ribisl et al ., 1993).…”

Section: Methodsmentioning

confidence: 99%

A new method to quantify postexercise ST‐deviation – the ST‐deficit. A study in men at high and low‐risk for coronary heart disease

Suurküla

Arvidsson

Fagerberg

et al. 2001

Clinical Physiology

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Effort-related myocardial ischaemia is frequently silent in elderly high-risk hypertensives and necessitates testing, preferably with computerized exercise ECG and heart rate adjusted ST criteria. A new quantitative variable to assess the postexercise rate-recovery loop in the time domain, the ST-deficit is described. This variable seems to effectively discriminate between subjects with low and high-risk for coronary heart disease and thus provides new information. Further studies are warranted to validate this variable against myocardial perfusion scintigraphy and coronary angiography.

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“…Chaitman [4]set, as said, the upper slope limit of a horizontal ST segment deviation to 1.0 mVs –1 . Ribisl et al [12]concluded that a value <0.7 mVs –1 correlates best with classic visual assessment of horizontal ST segment deviation during exercise but, somewhat confusingly, they suggested a lower value < 0.3 mVs –1 during recovery. At least none of our ST segment samples were unanimously interpreted as upsloping when the slope was ≤1.2 mVs –1 .…”

Section: Discussionmentioning

confidence: 99%

Visual versus Computerized Analysis of Upsloping ST Segment Depression in the Exercise Electrocardiogram

Walamies

Kööbi²,

Hämäläinen³

et al. 1999

Cardiology

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A slowly upsloping ST segment depression is an abnormal, and a rapidly upsloping ST segment depression is a normal exercise ECG response. We investigated the agreement of expert physicians on the visual classification of the ST segment depression, and compared the (majority) vote with the computer-generated ST slope. A total of 206 exercise ECG leads with an amplitude of the ST segment depression ≥0.15 mV and a ST segment slope ≥0.5 mVs^–1 were evaluated. All three interpreters agreed in 68 cases, two agreed in 123 cases, and all disagreed in 15 cases. Intraobserver agreement was 61%. The ST segment slope was significantly (p < 0.001) greater in leads generally interpreted as rapidly upsloping (n = 38; 2.1 ± 0.8 mVs^–1), than in those interpreted as slowly upsloping (n 121; 1.3 ± 0.6 mVs^–1) or horizontal (n = 32; 1.1 ± 0.4 mVs^–1), although there was some overlap. Thus, standardization of the computer-assisted exercise ECG interpretation should be continued.

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Comparison of computer ST criteria for diagnosis of severe coronary artery disease

Cited by 25 publications

References 26 publications

<b>Comparison of Exercise QRS Amplitude Changes in Patients with Slow Coronary Flow Versus Significant Coronary Stenosis</b>

<b>Comparison of Exercise QRS Amplitude Changes in Patients with Slow Coronary Flow Versus Significant Coronary Stenosis</b>

A new method to quantify postexercise ST‐deviation – the ST‐deficit. A study in men at high and low‐risk for coronary heart disease

Visual versus Computerized Analysis of Upsloping ST Segment Depression in the Exercise Electrocardiogram

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