Comparison of ST segment/heart rate index to standard ST criteria for analysis of exercise electrocardiogram.

Lachterman, Bruce; Lehmann, Kenneth G.; Detrano, Robert; Neutel, Joel M.; Froelicher, Victor F.

doi:10.1161/01.cir.82.1.44

Cited by 86 publications

(15 citation statements)

References 23 publications

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“…The validity of use of the HR-ST-loop for distinguishing between ischemic STsegment depression and non-ischemic ST-depression has already been demonstrated in various exercise tests including ergometer and treadmill tests (21,26). Wewere the first to apply the HR-ST-loop to Holter ECGmonitoring and demonstrated the usefulness of this combinedevaluation method (20).…”

Section: Discussionmentioning

confidence: 93%

Efficacy of Anti-anginal Drugs in the Treatment of Angina Pectoris Associated with Silent Myocardial Ischemia. Importance of Quantitative Holter ECG Data for Patient Activity.

Ino-Oka¹,

Sagawa

Takahashi

et al. 2000

Intern. Med.

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MethodsWe evaluated the clinical efficacy of transdermal nitroglycerin (NTG-TTS), a patch application of a nitrate, in the treatment of 27 patients with angina pectoris who had asymptomatic myocardial ischemic (SMI) attacks, using a double-blind cross-over method. Evaluation was made using Holter ECGand patient activity data.Results In frequency and duration of continuation of SMIepisodes, no significant differences were noted between the observation and placebo treatment periods, while the values of both these parameters were decreased significantly in the active drug treatment period compared with those in the observation and placebo treatment periods. Critical heart rate, the heart rate at the initiation of ST-segment depression, was significantly higher during the period of active drug treatment than during the placebo treatment and observation periods. In SMIfrequency index, which was determined by adjusting the SMIfrequency for the numberof steps taken, there were no significant differences between the 3 periods. The SMI time index was significantly lower in the active drug treatment period than in the observation period. Conclusions These results indicated that the clinical evaluation of the efficacy of anti-anginal drugs against SMI should take into consideration individual patient activity data.

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Section: Discussionmentioning

confidence: 93%

Efficacy of Anti-anginal Drugs in the Treatment of Angina Pectoris Associated with Silent Myocardial Ischemia. Importance of Quantitative Holter ECG Data for Patient Activity.

Ino-Oka¹,

Sagawa

Takahashi

et al. 2000

Intern. Med.

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“…25,26 This study is unique in comparing the visual and computer interpretation of ST segments during exercise with the coronary anatomy, which includes the particular artery or arteries involved, the number of arteries with ~7 0 % stenosis, and the degree of stenosis. In our study, three observers and the computer evaluated nine leads during each min of exercise and recovery and correlated these findings with the specific coronary artery or arteries with 270% stenosis for 104 men.…”

Section: Discussionmentioning

confidence: 99%

Is computer interpretation of the exercise electrocardiogram a reasonable surrogate for visual reading?

Malík¹,

Mickelson²,

Hartigan³

et al. 1997

Clinical Cardiology

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Background: Interpretation of exercise tests as positive or negative is primarily based upon exercise‐induced ST segment changes. Consistently accurate measurements are difficult to obtain during exercise. Hypothesis: This study compared on‐line computer‐generated electrocardiographic (ECG) analysis with visual interpretation. The goals were to document the extent of agreement, establish reasons for disagreements, characterize ST‐segment depression (extent, onset, duration), and determine the sensitivity and ability to localize coronary artery disease for each method. Methods: Comparisons were made in 120 patients at eight Veterans Affairs Medical Centers. An exercise test was considered positive if > 1.0 mm horizontal or downsloping ST‐segment depression was detected 0.08 s after the J point during exercise or recovery. The ST‐segment depression had to be present on at least two successive ECG recordings 15 s apart. Computer interpretation was based on median averaged beats. Results: There was an 88% agreement of visual and computer interpretations [106/120 (both positive, n = 62; both negative, n = 44)]. The disagreements involved visual negative, computer positive in 10 cases and visual positive, computer negative in 4 cases. Correlation was excellent between methods for characterization of ST‐segment depression (p<0.0001). Sensitivity for detecting and the ability to localize coronary artery disease (≥70% stenosis) were similar for both methods. Conclusion: This computer algorithm using median averaged beats is a reasonable surrogate for visual interpretation of the exercise ECG, making it a valuable source of confirmation of physician readings in large research trials and in clinical settings.

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“…Some have argued that the ⌬ST/⌬HR index is statistically flawed because the respective weight given to both ST-segment depression and the change in HR response to exercise by the formula may be inaccurate. 72,73 Because of the possible flaws in this technique and the technical difficulty in doing the calculation, neither are commonly used in clinical practice. 74 …”

Section: Diagnostic Valuementioning

confidence: 99%

Exercise Stress Testing in Women

2010

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Marked reductions in cardiovascular mortality in women have occurred for the first time this decade as a result of advances in medical treatment, improvement in medical technology, and a greater focus on women and their cardiovascular risk. 1 Nonetheless, cardiovascular disease remains the No. 1 cause of death for women in the United States, and more women die from cardiovascular disease than men every year. 2 In addition, women with coronary artery disease (CAD) are more likely to have a poorer prognosis than men. 1,3,4 Women who have an acute myocardial infarction have a higher mortality than their male counterparts, and women who have symptoms of angina or an abnormal stress test are less likely to be referred for further diagnostic testing. 2,[5][6][7] Given these gender differences in the evaluation of possible CAD symptoms and the higher mortality due to CAD in women, critical steps should be taken to identify women at the earliest stage of presentation so that appropriate therapeutic strategies can be implemented. Nonetheless, identifying women with coronary disease can be a diagnostic challenge. The prevalence of CAD in younger women is low, and women tend to present with symptoms and CAD at older ages as compared with men. In addition, women may present with more atypical symptoms. 8 Women also have a lower prevalence of obstructive coronary disease, making diagnostic testing designed to detect focal areas of coronary stenosis less sensitive and specific in this population. 9 Currently, exercise stress testing is the most commonly used method of diagnosing CAD in women, 10 -12 Historically, exercise stress testing in women has been thought to have a decreased diagnostic accuracy because of a lower prevalence of CAD in women, but most early studies evaluating stress testing as a diagnostic tool were performed in almost exclusively male cohorts. [15][16][17][18][19][20][21][22][23][24][25] Until recently, the representation of women in published studies was too small to determine any gender differences in test accuracy. The underrepresentation of women, as well as the bias in selection of women when included, may be the reason for the misconceptions regarding the value of exercise stress testing in women. Nonetheless, research on exercise stress testing in women has increased in the past decade, improving our understanding of the diagnostic and prognostic value of this modality in women.The purpose of this article is to review the literature regarding exercise stress testing in women, with a focus beyond ST-segment depression alone. It addition to interpretation of ECG changes with exercise, evaluation of exercise capacity, chronotropic index, heart rate (HR) recovery (HRR), blood pressure response, and Duke Treadmill Score (DTS) can be used to enhance the utility of exercise testing. The diagnostic and prognostic value of these non-ECG variables in women is reviewed, with a goal of highlighting the importance of exercise stress testing in women on the basis of the research available to date. ST-Segment...

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Comparison of ST segment/heart rate index to standard ST criteria for analysis of exercise electrocardiogram.

Cited by 86 publications

References 23 publications

Efficacy of Anti-anginal Drugs in the Treatment of Angina Pectoris Associated with Silent Myocardial Ischemia. Importance of Quantitative Holter ECG Data for Patient Activity.

Efficacy of Anti-anginal Drugs in the Treatment of Angina Pectoris Associated with Silent Myocardial Ischemia. Importance of Quantitative Holter ECG Data for Patient Activity.

Is computer interpretation of the exercise electrocardiogram a reasonable surrogate for visual reading?

Exercise Stress Testing in Women

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