Usefulness of a quantitative analysis of the recovery phase patterns of the ST-segment depression in the diagnosis of coronary artery disease

Diagnostic performance and partition values of exercise electrocardiographic variables in the detection of coronary artery disease – improved accuracy by using ST/HR hysteresis

“…These findings are in accord with the results reported from a large study of Lehtinen et al (1996) in which the diagnostic capacity of ST ⁄ HR hysteresis, ST ⁄ HR index, and end-exercise ST-segment depression were compared. In addition, the current data confirm the original reports by Bruce & McDonough (1969) and by Okin et al (1989), as well as the results of later studies (Bigi et al, 1994;Herpin et al, 1996;Suurküla et al, 2001;Svensbergh et al, 2004;Kronander et al, 2005) and indicate that by focusing on postexercise STsegment amplitude changes, a significant improvement in diagnostic accuracy of exercise ECG can be achieved. In fact, the currently measured ROC areas for the analysis of postexercise ST-segment amplitude remained indicative of significant diagnostic discrimination for a period of at least 2 min after the end of the exercise.…”

“…(1989), as well as the results of later studies (Bigi et al. , 1994; Herpin et al. , 1996; Suurküla et al.…”

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

“…(1996) presented ST/HR hysteresis which was the area of the rate‐recovery loop normalized for the change in heart rate for the first 3 min after exercise. A somewhat similar method was presented by Herpin who, instead of the area, used the average distance between the exercise part and the recovery part of the rate‐recovery loop for the first 5 min after exercise (Herpin et al ., 1996). Both these quantitative analyses of the rate‐recovery loop patterns improved the diagnostic performance of the exercise test for the detection of coronary artery disease.…”

“…Among these are different variables that relate the magnitude of ST‐segment depression to heart rate during or after the exercise, the ST/HR slope and the rate–recovery loop (Elamin et al ., 1980; Okin et al ., 1989; Kligfield et al ., 1989, 1993; Okin & Kligfield, 1989; Herpin et al ., 1996; Lehtinen et al ., 1996; Gullestad et al ., 2000). These test variables have been shown to improve the diagnostic accuracy of the exercise ECG test (Okin et al ., 1988; Schiariti et al ., 1991; Kligfield et al ., 1993; Goldberg et al ., 1995; Herpin et al ., 1996; Lehtinen et al ., 1996). They have also been shown to improve the prediction of future coronary events in large population studies (Okin et al ., 1991, 1996).…”

Evaluation of ST‐segment changes during and after maximal exercise tests in one‐, two‐ and three‐vessel coronary artery disease

“…This loop develops in opposite directions in individuals with and without coronary artery disease (3). Not only the direction but also the shape of the ST/HR recovery loop is of importance for the diagnosis of coronary artery disease (4)(5)(6). Earlier studies have shown that a downsloping ST-segment in the post-exercise period is prevalent in severe coronary artery disease and indicates a less favorable prognosis (7)(8)(9).…”