Heart rate adjustment of ST-segment depression for reduction of false positive electrocardiographic responses to exercise in asymptomtic men screened for coronary artery disease

Okin, Peter M.; Kligfield, Paul; Milner, Mark R.; Goldstein, Steven A.; Lindsay, Joseph

doi:10.1016/0002-9149(88)90545-0

Cited by 29 publications

(3 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Because both the AST/HR index and ST/HR slope are continuous variables that reflect this relation in a quantitative fashion, their values can be accurately related to both the presence and severity of CHD. 3,12,13,25,29 In contrast, during early recovery, the magnitude of ST segment depression in patients with CHD generally remains greater than expected for the rapidly decreasing myocardial oxygen demand that results from an abrupt lowering of exercise load, producing a counterclockwise rate-recovery loop pattern.14 Because direction of the rate-recovery loop is not dependent on a particular threshold magnitude of ST segment depression at peak exercise, sensitivity of this method for identifying CHD may be less affected by the anatomic and functional severity of underlying coronary obstruction than are standard and heart rate-adjusted criteria that are derived from exercise-phase data alone.14 Although the AST/HR index significantly concentrates risk in the present study, the more complex ST/HR slope method might have performed with greater accuracy. Although the ST/HR slope relates changing ST depression to heart rate changes occurring during maximum ischemia, the AST/HR index relates overall ST depression to the total heart rate change during exercise.12,'325,29 Because this total change in heart rate may include a variable period of effort during which ischemia is absent, the AST/HR index should not as effectively normalize ST depression for oxygen demand during ischemia as does the maximal ST/HR slope and, therefore, may not as accurately reflect the presence and severity of coronary obstruction.29 Further study is necessary to evaluate the potential of this method to stratify risk of coronary events; this may be facilitated by the recent implementation of accurate, on-line computerized calculation of the ST/HR slope.50…”

Section: Study Populationmentioning

confidence: 99%

Heart rate adjustment of exercise-induced ST segment depression. Improved risk stratification in the Framingham Offspring Study.

et al. 1991

View full text Add to dashboard Cite

show abstract

Section: Study Populationmentioning

confidence: 99%

Heart rate adjustment of exercise-induced ST segment depression. Improved risk stratification in the Framingham Offspring Study.

et al. 1991

View full text Add to dashboard Cite

show abstract

“…The prevalence of obstructive lesions in coronary angiography ranged from 21% to 70% in studies on asymptomatic patients with a positive exercise electrocardiogram [85][86][87][88]. However, in a meta-analysis based on 44 studies where stress echocardiography and single photon emission tomography (SPECT) were directly compared in patients without prior acute myocardial infarction and without past history of known ischemic heart disease, the two techniques detected obstructive CAD with a sensitivity of 85% and 87% and a specificity of 77% and 64% respectively [84].…”

Section: Anatomic Substratementioning

confidence: 99%

Diagnosis and Management of Chronic Coronary Artery Disease

Triposkiadis¹,

Starling²,

Stefanadis³

2007

Current Cardiology Reviews

View full text Add to dashboard Cite

Coronary artery disease (CAD) usually coexists with atherosclerosis of other arterial trees and is accelerated by several risk factors. It may remain asymptomatic for a long period affecting the vessel wall with no lumen encroachment. However, its course may change dramatically when complicated by thrombosis arising from ruptured atherosclerotic plaques leading to myocardial infarction or sudden death, which are often the first manifestations. Alternatively, thrombosis may remain clinically silent yet contributing to the natural history of plaque progression and ultimately luminal stenosis resulting in symptomatic or asymptomatic myocardial ischemia. Thus, chronic CAD may be classified as: 1) Asymptomatic/non-ischemic (subclinical) including asymptomatic patients without stress-induced myocardial ischemia and one or more of the following: a) non-coronary forms of atherosclerotic disease, b) diabetes, c) high Framingham Risk Score (FRS) or European Heart Score (EHS), and d) intermediate FRS or EHS and either a coronary artery calcium score 100 or a carotid intima-media thickness score 1mm; 2) Asymptomatic/ischemic, including asymptomatic patients with a positive stress-test and one or more of the following: a) non-coronary forms of atherosclerosis, b) diabetes, and c) intermediate or high FRS or EHS; 3) Symptomatic/ ischemic, including patients with effort angina and stress test-induced myocardial ischemia. Lifestyle modification, aspirin, and lipid lowering with statins, are the mainstay of treatment in all patients with chronic CAD. Antiischemic pharmacotherapy should be considered in patients with evidence of myocardial ischemia and reperfusion treatment in selected patients with obstructive lesions in coronary angiography.

show abstract

“…To improve the accuracy of the exercise ECG, various indices have been proposed, including the degree of STsegment depression, 1,16,17 R wave amplitude changes, 18,19 ST/HR slope, 20,21 ST index, 21,22 QT dispersion, 2,23 ST slope 1,7,16,24,25 and concomitant changes in hemodynamic parameters. 1,17 Each has been reported to improve accuracy; however, only a few are in clinical use, presumably because there has not been a dramatic increase in accuracy, the method is complicated or time-consuming, or both.…”

Section: Diagnostic Value Of St Slopementioning

confidence: 99%

Diagnostic Value of the Recovery Time-Course of ST Slope on Exercise ECG in Discriminating False-From True-Positive ST-Segment Depressions

Sakuragi

Takaki

Taguchi

et al. 2004

Circ J

View full text Add to dashboard Cite

ender and several anatomical and functional characteristics are associated with an increased incidence of abnormal ST-segment responses to exercise in the absence of coronary artery disease (CAD). Subsets with an increased incidence of false-positive (FP) exercise ECG responses with respect to ischemia include middle-aged women, 1-3 and patients with mitral valve prolapse. 1,4,5 Patients with left ventricular hypertrophy (LVH) form a separate subset with the potential for inadequate myocardial perfusion in the absence of significant CAD. 4,6 Advanced ECG analysis approaches applicable to the clinical evaluation of the standard exercise ECG in these subjects are currently unavailable and need to be developed.The ST slope, usually computed as the slope between the J-point and the J80, has been mainly used for differentiating the configuration of ST-segment depression (ie, upsloping, horizontal, and downsloping). The latter two are considered more specific for myocardial ischemia than the upsloping shape. 1,7 However, in CAD, the shape often changes with time during the test and a relatively characterCirculation Journal Vol. 68, October 2004 istic time-course can be seen. ST-segment depression during exercise changes from upsloping (or horizontal) to downsloping in the early recovery at 2-4 min; that is, the ST slope decreases in early recovery ( Fig 1A). 7,8 Subsequently, both ST-segment depression and the ST slope return gradually toward the baseline; that is, the ST slope increases in late recovery. On the other hand, in many subjects with FP ST-segment depression (FPD) (Fig 1B), the downsloping shape appears, not in the early, but in the late recovery. Unlike in CAD, the ST slope monotonically decreases from early to late recovery, possibly serving as the differentiating characteristic. 5,8 We thus hypothesized that the temporal changes in the ST slope from early to late recovery are capable of differentiating these 2 groups and we performed high-resolution computer analysis of the ST slope in the recovery in a relatively large population with normal resting ECGs. Because the majority of subjects with normal exercise single-photon emission computed tomography (SPECT) results are no longer referred for coronary angiography in the clinical practice, we used this technique for the selection of FPD subjects. True-positive (TP) results were defined when both angiographic and exercise SPECT images were abnormal. Methods Study PopulationFrom the digitized ECG recordings consecutively obtained during routine treadmill testing for the evaluation of CAD, 198 patients (62±9 years) with an exerciseinduced significant ST-segment depression were recruited. Patients were excluded if they had resting ECG abnor- Methods and ResultsTreadmill digitized ECG from patients with significant ST-segment depressions and normal resting ECG were analyzed in 134 patients with CAD on angiography (>50% narrowing) and reversible perfusion defects (TP group), and 64 subjects with normal perfusion (FP group) on exercise single photon emissi...

show abstract

Heart rate adjustment of ST-segment depression for reduction of false positive electrocardiographic responses to exercise in asymptomtic men screened for coronary artery disease

Cited by 29 publications

References 29 publications

Heart rate adjustment of exercise-induced ST segment depression. Improved risk stratification in the Framingham Offspring Study.

Heart rate adjustment of exercise-induced ST segment depression. Improved risk stratification in the Framingham Offspring Study.

Diagnosis and Management of Chronic Coronary Artery Disease

Diagnostic Value of the Recovery Time-Course of ST Slope on Exercise ECG in Discriminating False-From True-Positive ST-Segment Depressions

Contact Info

Product

Resources

About