Significance of 'recovery ST-segment depression' in exercise stress test
Rockey Katheria1, Subramanyam K Setty1, B S Arun1
1Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.
Insights
ST-segment depression during exercise stress tests is significant for diagnosing coronary artery disease. Depression during recovery shows the highest specificity and predictive values for significant coronary artery disease.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Exercise Physiology
Background:
- Exercise stress testing is a common method for diagnosing coronary artery disease (CAD).
- ST-segment depression during stress testing can indicate myocardial ischemia.
- The significance of ST-segment depression during the recovery phase is less understood compared to during stress.
Purpose of the Study:
- To compare the diagnostic significance of ST-segment depression during the recovery phase versus the stress phase, and both phases, in exercise stress tests.
- To evaluate the sensitivity, specificity, and predictive values of ST-segment depression patterns in identifying significant coronary artery disease (CAD).
Main Methods:
- A study of 300 patients with positive exercise stress tests who underwent coronary angiography (CAG).
- Patients were categorized into three groups based on ST-segment depression during stress, recovery, or both phases.
- Diagnostic performance metrics (sensitivity, specificity, predictive values) were analyzed and compared across groups.
Main Results:
- 96% of patients with ST-depression restricted to the recovery phase had significant CAD, higher than other groups.
- ST-depression in the recovery phase demonstrated the highest specificity (96.92%), positive predictive value (96%), and negative predictive value (25.2%).
- Accuracy was highest in the group experiencing ST-depression during both stress and recovery phases.
Conclusions:
- ST-segment depression confined to the recovery phase of an exercise stress test is a highly specific indicator of significant coronary artery disease.
- While recovery-phase ST depression offers high specificity and predictive values, the combination of stress and recovery phase depression yields the highest overall accuracy.
- These findings refine the interpretation of exercise stress test results for diagnosing CAD.
Objective:
To study the significance of ST-segment depression during 'recovery' compared to that 'during stress' and 'both the phases' in exercise stress test.
Methods:
Patients with positive exercise stress test who underwent coronary angiography (CAG) from 1st January 2017 to 31st December 2018 were studied. Patients were divided into 3 groups- Group A with ST-depression restricted to recovery phase, group B with ST-depression restricted to stress phase and group C with ST-depression seen both during exercise and recovery. All patients underwent CAG. Sensitivity, specificity, and predictive values of each of these groups in diagnosis of significant coronary artery disease (CAD) were analysed and compared.
Results:
Total 300 patients were studied. Mean age of the study population was 48.77 ± 7.94 years. 78.3% of patients with positive exercise stress test had significant CAD. 96% of patients in group A had significant CAD, which was higher than in group B (88.9%) & group C (70.1%). The specificity, positive predictive value and negative predictive value of ST-segment depression in group A (96.92%, 96% and 25.2% respectively) were higher than that of ST-depression in group B (89.23%, 88.89% and 24.47% respectively) and group C (13.85%, 70.05% and 7.96% respectively). Sensitivity and accuracy of ST-depression in group A were lower (20.43% and 37% respectively), compared to other 2 groups.
Conclusion:
Patient with ST-depression restricted to recovery phase had highest specificity, positive predictive value, and negative predictive value. However, accuracy was highest in group with both stress phase and exercise ST-segment depression.
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