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

Abstract

Patients with three-vessel disease had a significantly shorter time to >1 mm ST-depression during exercise and more often an abnormal post-exercise ST/HR reaction than those with one-vessel disease.

ST‐segment deviations during pacing‐induced increased heart rate in patients without coronary artery disease

“…Previous studies (Lehtinen et al ., 1996; Bjurö et al ., 2004) have suggested patterns for ST changes during increased HR in exercise testing, and our results correspond well with several 12 lead ECG studies to describe such algorithms, including an ST/HR index (Kligfield et al ., 1989; Lachterman et al ., 1990) or ST/HR slope (Okin & Kligfield, 1989) for ST magnitude adjustment or for improved specificity for ischemia criteria. The published experience with vectorcardiographic ST magnitudes in relation to HR and QRS magnitude demonstrated an elevated STC‐VM at maximal exercise in healthy subjects but did not explore the relation of stepwise HR increases and STC‐VM (Pilhall et al ., 1992).…”

Cardiopulmonary Exercise Testing: Relevant but Underused

“…Heart rate responses (chronotropic responses and HR recovery [HRR]), ischemic changes (ST elevation or depression), conduction disease, and arrhythmias are all important considerations that should be documented during exercise. 60,61 Heart Rate Reserve Heart rate control is regulated by autonomic responses. Parasympathetic withdrawal and sympathetic activation 62 work in combination to determine HR acceleration during exercise.…”

Exercise Electrocardiogram Testing

“…A relatively simple quantification of the raterecovery loop involves calculation of the ST-segment "deficit" between recovery phase ST depression at 3.5 minutes and the ST depression at the corresponding heart rate during exercise. 89,93 ST/HR hysteresis, as developed by Lehtinen et al, 88,94,95 integrates the area of ST-segment depression with respect to heart rate that is included in the exercise and recovery loop over the heart rate range included in the first 3 minutes of recovery. This integral is then divided by the heart rate difference (ie, the maximum heart rate during exercise minus the minimum heart rate during recovery) of the integration interval to normalize the result with respect to the postexercise heart rate decline.…”