Comparison of the diagnostic accuracy of different methods of measurement of heart rate-adjusted ST-segment depression during exercise testing for identification of coronary artery disease

Herpin, D.; Ferrandis, J; P, Borderon; Gaudeau, B; Ragot, Stéphanie; Gigon, Sandrine; Demange, J

doi:10.1016/s0002-9149(99)80325-7

Cited by 9 publications

(5 citation statements)

References 17 publications

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“…This was corroborated by classification results for ST/HR hysteresis in our study population (SE=89%, SP = 75%), supporting the idea that the recovery phase of the exercise test provides valuable diagnostic information on cardiovascular disease (OKIN et al, 1989;MORSHEDI-MEIBODI et al, 2002;WATANABE et al, 2001). The whole HR-adjusted ST-based indexes improved EX by approximately 20% over ST indexes in our study population (86% against 65%), which is in accordance with previous works (DETRANO et al, 1986;MORISE and DUVAL, 1995;HERPIN et al, 1995;OKIN and KLIGFIELD, 1995b;LEHTINEN et al, 1996;LEHTINEN, 1999;MORISE, 1997). In HERPIN et al (1995), different HR-adjusted ST-based indexes, not including ST/HR hysteresis, were studied, achieving a higher specificity than standard ST measurement but not better sensitivity.…”

Section: Ecg Indexes Diagnostic Performancesupporting

confidence: 91%

“…The whole HR-adjusted ST-based indexes improved EX by approximately 20% over ST indexes in our study population (86% against 65%), which is in accordance with previous works (DETRANO et al, 1986;MORISE and DUVAL, 1995;HERPIN et al, 1995;OKIN and KLIGFIELD, 1995b;LEHTINEN et al, 1996;LEHTINEN, 1999;MORISE, 1997). In HERPIN et al (1995), different HR-adjusted ST-based indexes, not including ST/HR hysteresis, were studied, achieving a higher specificity than standard ST measurement but not better sensitivity. In contrast, in our study both sensitivity and specificity were improved by HRadjusted ST indexes (SE = 90%, SP = 79% against SE = 65%, SP = 66%), suggesting that ST/HR hysteresis can increase the sensitivity of the exercise test.…”

Section: Ecg Indexes Diagnostic Performancesupporting

confidence: 91%

“…Several reported indexes can be extracted from the diagram of the ST depression against the HR (often referred to as an ST/HR diagram) during an exercise test: HRadjusted ST depression (DETRANO et al, 1986;MORISE and DUVAL, 1995;HERPIN et al, 1995;OKIN and KLIGFIELD, 1995b;MORISE, 1997), HR-adjusted ST integral (OKIN et al, 1991b;HERPIN et al, 1995) and ST/HR slope (KLIGFIELD and OKIN, 1999) are among them. Conventional HR-adjusted ST indexes usually consider only the exercise phase of the test.…”

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confidence: 99%

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Coronary artery disease diagnosis based on exercise electrocardiogram indexes from repolarisation, depolarisation and heart rate variability

Bailón

Mateo

Olmos

et al. 2003

Med. Biol. Eng. Comput.

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Several indexes have been reported to improve the accuracy of exercise test electrocardiogram (ECG) analysis in the diagnosis of coronary artery disease (CAD), compared with the classical ST depression criterion. Some of them combine repolarisation measurements with heart rate (HR) information (such as the so-called ST/HR hysteresis); others are obtained from the depolarisation period (such as the Athens QRS score); finally, there are heart rate variability (HRV) indexes that account for the nervous system activity. The aim of this study was to identify the best exercise ECG indexes for CAD diagnosis. First, a method to automatically estimate repolarisation and depolarisation indexes in the presence of noise during a stress test was developed. The method is divided into three stages: first, a preprocessing step, where QRS detection, filtering and baseline beat rejection are applied to the raw ECG, prior to a weighted averaging; secondly, a post-processing step in which potentially noisy averaged beats are identified and discarded based on their noise variance; finally, the measurement step, in which ECG indexes are computed from the averaged beats. Then, a multivariate discriminant analysis was applied to classify patients referred for the exercise test into two groups: ischaemic (positive coronary angiography) and low-risk (Framingham risk index < 5%). HR-corrected repolarisation indexes improved the sensitivity (SE) and specificity (SP) of the classical exercise test (SE = 90%, SP = 79% against SE = 65%, SP = 66%). Depolarisation indexes also achieved an improvement over ST depression measurements (SE = 78%, SP = 81%). HRV indexes obtained the best classification results in our study population (SE = 94%, SP = 92%) by means of the very high-frequency power (VHF) (0.4-1 Hz) at stress peak.

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Section: Ecg Indexes Diagnostic Performancesupporting

confidence: 91%

Section: Ecg Indexes Diagnostic Performancesupporting

confidence: 91%

mentioning

confidence: 99%

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Coronary artery disease diagnosis based on exercise electrocardiogram indexes from repolarisation, depolarisation and heart rate variability

Bailón

Mateo

Olmos

et al. 2003

Med. Biol. Eng. Comput.

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“…ST‐depression at exercise is known to be reduced by β‐blockers (Gianelly et al ., 1969). The superiority of the heart rate adjusted ST criteria has been claimed by several authors (Okin et al ., 1988; Kligfield et al ., 1989, 1993; Herpin et al ., 1995; Lehtinen et al ., 1996) and also regarding their relative independence of β‐blockade and previous myocardial infarction by Ameisen et al . (1986), Okin et al .…”

Section: Discussionmentioning

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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“…Other researchers have also shown ST/HR analysis integrating exercise and recovery to improve the diagnostic capacity of exercise ECG [15][16][17][18]. However, the majority of patients in the previous studies have been men, and hitherto the diagnostic performance of ST/HR hysteresis in women has been unknown.…”

Section: Discussionmentioning

confidence: 99%

Exercise electrocardiography detection of coronary artery disease by ST-segment depression/heart rate hysteresis in women: The Finnish Cardiovascular Study

Svart

Lehtinen

Nieminen

et al. 2010

International Journal of Cardiology

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Comparison of the diagnostic accuracy of different methods of measurement of heart rate-adjusted ST-segment depression during exercise testing for identification of coronary artery disease

Cited by 9 publications

References 17 publications

Coronary artery disease diagnosis based on exercise electrocardiogram indexes from repolarisation, depolarisation and heart rate variability

Coronary artery disease diagnosis based on exercise electrocardiogram indexes from repolarisation, depolarisation and heart rate variability

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

Exercise electrocardiography detection of coronary artery disease by ST-segment depression/heart rate hysteresis in women: The Finnish Cardiovascular Study

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