Correlation of computer-quantitated treadmill exercise electrocardiogram with arteriographic location of coronary artery disease

McHenry, Paul L.; Phillips, John; Knoebel, Suzanne B.

doi:10.1016/0002-9149(72)90149-x

Cited by 166 publications

(20 citation statements)

References 13 publications

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“…'5-17, [22][23][24] In addition, the 20 had a double Master's test, 17 were positive, and 14 of the latter had ST change > 2 mm. Data from the present study confirm this finding.…”

Section: Discussionmentioning

confidence: 99%

Graded Exercise Stress Tests in Angiographically Documented Coronary Artery Disease

et al. 1974

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SUMMARYGraded exercise stress tests performed on 650 consecutive patients with proven or suspected coronary disease undergoing evaluation by cardiac catheterization were correlated with clinical, hemodynamic, and angiographic findings. Among 451 patients with significant coronary stenosis, 332 (74%) had interpretable stress tests and 65% of these were positive (sensitivity). The rate of "false positives" was 8%.The clinical syndrome of typical angina identified significant coronary disease in 89% of the patients, and 58% of that group had a positive exercise test defined by objective electrocardiographic criteria.Patients were not eliminated from this study because of recent digitalis ingestion. Although a higher frequency of uninterpretable exercise tests was found in this group (40%), the test results reflected more severe coronary disease. None of the patients with "false positive" tests were taking digitalis. It is concluded that recent digitalis ingestion should not be considered a contraindication for exercise stress testing.Among the patients with interpretable exercise tests, the angiographic severity of coronary artery disease correlates strongly with the frequency of positive tests (40%, 66%, and 76%, with 70% or greater occlusion of one, two or three vessels respectively). Left main coronary stenosis of 70% or greater was associated with more severe ST segment changes, inability to achieve target heart rate during stress, and a lower maximum heart rate during exercise. The angiographic occurrence of collateral vessels was related to the extent of coronary disease and was associated with a higher percentage of positive exercise tests; no protective effect of collateral circulation could be demonstrated. Patients with abnormal resting hemodynamics or left ventricular asynergy had no significant difference in the frequency of positive tests after adjustment for the angiographic severity of disease.

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“…'5-17, [22][23][24] In addition, the 20 had a double Master's test, 17 were positive, and 14 of the latter had ST change > 2 mm. Data from the present study confirm this finding.…”

Section: Discussionmentioning

confidence: 99%

Graded Exercise Stress Tests in Angiographically Documented Coronary Artery Disease

et al. 1974

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“…The sensitivity of the exercise ECG test [17, 18] was in the range of 40% for the detection of single-vessel disease, 66% for the detection of two-vessel disease and 76% for the detection of three-vessel disease. In our study, the sensitivity of the ACC/AHA criteria in detecting left main coronary disease, three-vessel coronary disease or two-vessel coronary disease with proximal left anterior descending coronary artery obstruction was found to be close to 100%.…”

Section: Discussionmentioning

confidence: 99%

Angiographic Correlates of the Treadmill Scores in Non-High-Risk Patients with Unstable Angina

et al. 2007

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Background: There has been no clear consensus regarding the optimum definition of a high-risk exercise ECG test. The aim of this study is to compare the diagnostic accuracy of several treadmill scores [American College of Cardiology/American Heart Association (ACC/AHA) High-Risk Criteria for exercise testing, Duke Treadmill Score, Veterans Affairs and West Virginia Prognostic Score, ST/Heart Rate Index] with the ST-segment depression analysis in the detection of significant and severe coronary disease as determined by coronary angiography. Methods: The study included a cohort of 248 consecutive patients admitted to hospital for unstable angina. Results: The sensitivities of the ACC/AHA High-Risk Criteria and the ST depression ≧1 mm were 89.02 and 76.83%, respectively, for the detection of significant coronary artery disease, and 96.15 and 86.54% for the detection of severe coronary artery disease. The specificities of the Duke Treadmill Score and the ST depression ≧1 mm were 96.43 and 73.81%, respectively, for the detection of significant coronary artery disease, and 81.63 and 47.45% for the detection of severe coronary artery disease. Conclusions: The ACC/AHA High-Risk Criteria and Duke Treadmill Score provided relevant diagnostic information not available from the ST segment analysis alone.

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“…The ECG data reported here for the entire group are less satisfactory than in a previous study from our laboratory9 in which in 192 symptomatic patients without myocardial infarction, the sensitivity and the specificity of the exertional ECG were 91% and 70%, respectively. This discrepancy is likely explained by the use of only three orthogonal leads instead of the 12 conventional ECG leads and because we considered only the horizontal depression of the ST segment, while many other computerized systems do not take into account the slope of the ST-segment and/or use heart-rate-dependent criteria.19 21,22 When interpreting the response to a diagnostic exercise test, one must take into account both the ECG response and the myocardial scans. When the results of both tests are in agreement, as in 110 patients (69%) of the present study, an abnormal response clearly indicates the presence of CAD (100% of true positives) and a normal response strongly suggests the absence of CAD (84% of true negatives).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of exercise electrocardiography and thallium myocardial scintigraphy in patients without previous myocardial infarction: a Bayesian approach.

Melin¹,

Piret²,

Vanbutsele³

et al. 1981

Circulation

122

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SUMMARY The clinical value of combining exertional ECG and postexertional thallium (201T1) scintigraphy was assessed in 160 patients (130 men and 30 women) suspected of having coronary artery disease (CAD) who underwent a coronary arteriography. Based on sex and history, the patients were subdivided in two groups with different prevalences of CAD: Group 1 (high prevalence of CAD = 90%) included 98 men with typical angina pectoris (AP) and group 2 (low prevalence of CAD = 18%) included 32 men and 30 women with atypical AP.Compared with the exertional ECG, myocardial scintigraphy was more sensitive (87% vs 74%) and more specific (89% vs 70%) for the diagnosis of CAD. The combination of the ECG and scintigraphic data was useful if both tests gave concordant results: 100% of true positives (n = 67) and 84% of true negatives (n = 43). In case of discordant results (n = 50), no firm diagnostic conclusion could be made due to the many false-positive (27%) and false-negative (25%) scintigrams.These results are easier to interpret when the prevalence of CAD is taken into account. According to Bayes' theorem, abnormal exercise results confirm CAD when the prevalence is high and normal results rule out CAD when the prevalence is low; also, a normal response to exercise has no predictive value when the prevalence is high. When the prevalence is low, an abnormal ECG or thallium has low predictive value but concordant abnormal responses are highly predictive for CAD (100% of true positives).EXERCISE myocardial perfusion scintigraphy with thallium-201 is useful for detecting myocardial ischemia due to coronary artery disease (CAD) and seems more reliable than the exertional ECG. '-5 In symptomatic patients, the characteristics of the complaints are important and, from a well-taken history, one can evaluate the likelihood of CAD.8 12 Several reports on exertional ECG have indicated that the diagnostic information provided by the test was largely determined by the prevalence of the disease within the population.9" [13][14][15][16][17] This study was undertaken to assess the diagnostic value of exercise thallium scintigraphy and its combination with exertional ECG; in order to analyze the influence of the prevalence of CAD, the patients were subdivided in groups according to the information provided by the history. The prevalence of CAD is almost 100% after an acute myocardial infarction, so patients with a history of infarction were excluded. Material One hundred sixty patients, 130 men and 30 women, suspected of CAD but without evidence of a previous myocardial infarction, were studied. They underwent a multistage maximal exercise test 1 to several days before the arteriographic study. These patients were studied because of the presence of chest pain. Before the exercise test, the patients were carefully questioned by the same physician. From the clinical history, the complaints were subjectively judged to be typical or atypical of angina pectoris (AP). As in a previous study,9 this judgment was based on the location, qualit...

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Correlation of computer-quantitated treadmill exercise electrocardiogram with arteriographic location of coronary artery disease

Cited by 166 publications

References 13 publications

Graded Exercise Stress Tests in Angiographically Documented Coronary Artery Disease

Graded Exercise Stress Tests in Angiographically Documented Coronary Artery Disease

Angiographic Correlates of the Treadmill Scores in Non-High-Risk Patients with Unstable Angina

Diagnostic value of exercise electrocardiography and thallium myocardial scintigraphy in patients without previous myocardial infarction: a Bayesian approach.

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