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False positive ECG and coronary heart disease
U N Jajoo1, K P Rao, S P Kalantri
1Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha.
The Journal of the Association of Physicians of India
|April 1, 1993
Summary
Coronary heart disease prevalence was very low in a rural community. Exercise tests showed false positives due to labile electrocardiographic changes, indicating poor reproducibility.
Area of Science:
- Cardiology
- Preventive Medicine
- Epidemiology
Background:
- A 1983 cross-sectional study in a rural community indicated a low prevalence of probable coronary heart disease (CHD) based on resting electrocardiograms.
- A seven-year follow-up study was conducted to assess the long-term outcomes of individuals identified as suspects.
Purpose of the Study:
- To evaluate the morbidity and mortality rates of suspected coronary heart disease cases over a seven-year period.
- To assess the diagnostic accuracy and reproducibility of exercise stress testing in a rural population with suspected CHD.
Main Methods:
- A cohort of 179 individuals identified as suspects for coronary heart disease in 1983 was followed up until 1990.
- Symptom-limited maximal exercise tests were performed on 98 suspects, with a subset undergoing repeat testing after six months.
Main Results:
- No cases of coronary heart disease morbidity or mortality were observed in the 179 suspects during the seven-year follow-up.
- Of 98 suspects tested, 81 had negative exercise tests. Seventeen suspects exhibited asymptomatic exercise-induced ST depression (> 1.0 mm) but had excellent hemodynamic responses and effort tolerance.
- Eleven of twelve subjects who repeated the exercise test after six months no longer showed ST depression, suggesting poor reproducibility.
Conclusions:
- The study suggests a very low actual prevalence of coronary heart disease in this rural population, despite initial electrocardiogram findings.
- Exercise stress testing demonstrated a high rate of false positives and poor reproducibility, likely due to labile electrocardiographic changes exacerbated by exercise.