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Analysis of ST/HR hysteresis improves long-term prognostic value of exercise ECG test.
KTH, School of Technology and Health (STH), Medical Engineering.
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2011 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 148, no 1, 64-9 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: ST/HR hysteresis is one of the better diagnostic exercise ECG variables for coronary artery disease. This study evaluates the long-term prognostic value of ST/HR hysteresis in predicting acute myocardial infarction (AMI) and all-cause mortality in men and women.

METHODS: The study population consisted of 8317 patients who had undergone routine exercise test on bicycle ergometer at one Swedish centre. Information on AMI and all-cause mortality was obtained from national Swedish registers covering a mean follow-up period of 9.5 years.

RESULTS: The adjusted hazard ratio for AMI at a diagnostic cut point of ≤-20 µV for ST/HR hysteresis was 1.88 (95% CI, 1.62-2.17) in men and 2.31 (95% CI, 1.83-2.91) in women. For all-cause death the adjusted hazard ratio was 1.72 (95% CI, 1.52-1.96) in men and 1.90 (95% CI, 1.57-2.29) in women. The corresponding hazard ratios for ST-segment depression with horizontal or down-sloping ST-segment, ST-segment depression, ST/HR index, and ST/HR slope were lower. For comparison, the adjusted hazard ratio for AMI using maximal workload in percent of predicted was 2.02 (95% CI, 1.77-2.32) in men and 2.14 (95% CI, 1.71-2.67) in women. Area under the ROC curves for prediction of AMI was significantly larger using ST/HR hysteresis than using any of three other evaluated ECG indicators.

CONCLUSIONS: 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
2011. Vol. 148, no 1, 64-9 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:kth:diva-78280DOI: 10.1016/j.ijcard.2009.10.025ISI: 000288489300019PubMedID: 19903576ScopusID: 2-s2.0-79952818631OAI: diva2:498492
QC 20120301Available from: 2012-02-12 Created: 2012-02-08 Last updated: 2012-03-01Bibliographically approved

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Kronander, HåkanBrodin, Lars-ÅkeElmqvist, Håkan
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