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Improved capacity of exercise electrocardiography in the detection of coronary artery disease by focusing on diagnostic variables during the early recovery phase
2005 (English)In: Journal of Electrocardiology, ISSN 0022-0736, E-ISSN 1532-8430, Vol. 38, no 2, 130-138 p.Article in journal (Refereed) Published
Abstract [en]

The temporal distribution of the diagnostic information for the detection of coronary artery disease (CAD) provided by exercise-induced electrocardiographic (ECG) ST-segment amplitude changes in different ECG leads in men and women has not been fully investigated. To shed further light in this area, 1877 electrocardiograms selected from 8322 patients undergoing a routine exercise test on a bicycle ergometer were evaluated. ST-segment amplitude and the difference between heart rate-matched recovery and exercise ST-segment amplitudes (ST/HR difference) were measured. Coronary artery disease was verified angiographically in 669 patients and excluded in 1208 patients by angiography (n = 119), by myocardial scintigraphy (n = 250), or on clinical grounds (n = 839). The diagnostic performance of the 2 ECG methods used was assessed by constructing receiver operating characteristic curves for each sampling point every 12 seconds during 10 minutes of recovery as well as the last 4 minutes of exercise for the ST-segment amplitude. ST-segment amplitude performed better after exercise than during exercise and best within the first 2 minutes of recovery. Its diagnostic ability did not differ from the ST-amplitude hysteresis assessed by the difference between recovery ST-segment amplitude and exercise ST-segment amplitude at matched heart rate. Both methods performed better in men and the diagnostic information appeared mainly in leads I, -aVR, II, V-4, V-5, and V-6. The best discrimination of CAD is provided by analysis of ST-segment amplitude changes in 6 specific leads early during the recovery phase. This information should be targeted by exercise ECG diagnostic methods.

Place, publisher, year, edition, pages
2005. Vol. 38, no 2, 130-138 p.
Keyword [en]
exercise ECG test, computer analysis, ST depression, ST/HR analysis, myocardial ischemia, coronary artery disease
National Category
Medical Laboratory and Measurements Technologies
Identifiers
URN: urn:nbn:se:kth:diva-11331DOI: 10.1016/j.jelectrocard.2004.10.008ISI: 000229256900010OAI: oai:DiVA.org:kth-11331DiVA: diva2:274100
Note
QC 20100726Available from: 2009-10-27 Created: 2009-10-27 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Diagnostic and Prognostic Value of Exercise Electrocardiographic Test Variables in Coronary Artery Disease
Open this publication in new window or tab >>Diagnostic and Prognostic Value of Exercise Electrocardiographic Test Variables in Coronary Artery Disease
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The diagnostic performance of conventional analysis of the exercise electrocardiographic (ECG) test for the detection of coronary artery disease (CAD) is limited to 70-75%. The exercise ECG test is the most widely used non-invasive method for assessing CAD and even a small improvement in the diagnostic performance is important. The objective of this thesis was to investigate the diagnostic performance of the exercise ECG test for diagnosis of CAD and the prognostic performance of the test for predicting acute myocardial infarction (AMI), in both men and women.

In the diagnostic part of the present study, aimed at finding the optimal diagnostic information during the exercise and recovery phase, 1,877 electrocardiograms selected from 8,322 consecutive patients undergoing a routine exercise test on bicycle ergometer were evaluated. CAD was verified angiographically in 669 patients and excluded in 1,208 patients, by angiography (119 patients), by myocardial scintigraphy (250 patients), or on clinical grounds (839 patients).

The diagnostic performance of ST-segment amplitude, and the difference between heart rate (HR) matched recovery and exercise ST-segment amplitudes (ST/HR difference), were evaluated by constructing receiver operating characteristic (ROC) curves for each sample point every 12th second during 10 minutes of recovery as well as the last 4 minutes of exercise for the ST-segment amplitude. ST-segment amplitude performed better after exercise than during exercise and best within the first 2 minutes of recovery. Its diagnostic ability did not differ from the ST/HR difference. Both methods performed better in men than in women and the diagnostic information appeared mainly in leads I, -aVR, II, V4, V5 and V6.

The effect of different sampling rates (1, 2 and 5 samples/min) on the CAD discrimination ability of ST/HR loop area was evaluated by using ROC curves. A use of sampling frequency below 2 samples/min resulted in a significantly diminished diagnostic performance.

ST-segment and ST/HR variables were compared during exercise and during early post-exercise recovery in terms of diagnostic discrimination capacity and optimal partition values. Discriminating capacity of the methods was evaluated by the use of ROC areas. Partition values, providing the combination of the best sensitivity and specificity, were established. The results demonstrate that analysis of post-exercise ST/HR hysteresis offers the most accurate and gender indifferent identification of patients with CAD.

The prognostic part of the study included 8,317 of the 8,322 patients and covered a mean follow-up period of 9.5 years. This part of the study was used to evaluate the long-term prognostic value of ST/HR hysteresis in predicting AMI and all-cause mortality in men and women. ST/HR hysteresis appears to improve the prognostic ability of an exercise ECG test for AMI and all-cause mortality in a long term perspective compared to conventional ST-segment and ST/HR indicators in both genders and clearly more markedly in women.

Place, publisher, year, edition, pages
Stockholm: KTH, 2009. 65 p.
Series
Trita-STH : report, ISSN 1653-3836 ; 2009:3
Keyword
exercise ECG test, coronary artery disease, acute myocardial infarction
National Category
Medical Laboratory and Measurements Technologies
Identifiers
urn:nbn:se:kth:diva-11289 (URN)978-91-7415-457-3 (ISBN)
Public defence
2009-11-06, Sal 4-221, Alfred Nobels Allé 12, Huddinge, 09:00 (English)
Opponent
Supervisors
Note
QC 20100726Available from: 2009-10-14 Created: 2009-10-14 Last updated: 2010-07-26Bibliographically approved

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