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[Diagnostic value of ST depression corrected for heart rate in the post-exercise recovery period]
L Deluche1, H Douard, C Binquet
1Département des épreuves d'effort et de la réadaptation, Hôpital cardiologique du Haut-Lévêque, Pessac.
Insights
New electrocardiographic criteria, the ST/HR index and slope during recovery, show diagnostic accuracy similar to standard criteria for detecting coronary artery disease.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Electrocardiography
Context:
- Coronary artery disease (CAD) diagnosis relies on accurate interpretation of exercise stress tests.
- Standard electrocardiographic (ECG) criteria for CAD have limitations.
- Novel ST/HR indices during exercise and recovery warrant investigation.
Purpose:
- To evaluate the diagnostic value of new ST/HR index and ST/HR recovery slope criteria for CAD.
- To compare these new criteria against standard ST depression criteria and Detrano's exercise ST/HR indices.
- To assess the diagnostic performance of the exercise-recovery loop.
Summary:
- Eighty-eight subjects with suspected CAD underwent exercise stress testing and coronary angiography.
- Receiver Operating Characteristic (ROC) analysis identified thresholds for ST/HR recovery index (> or = 2.1 microV/bpm) and ST/HR recovery slope (> or = 2.52 microV/bpm).
- Exercise ST/HR indices demonstrated superior diagnostic areas under the ROC curve (0.96) compared to standard criteria (0.92) and recovery indices (0.86), though not statistically significant.
Impact:
- ST/HR index and slope during recovery achieved diagnostic accuracies of 80% and 77%, comparable to standard ST criteria (84%).
- The exercise-recovery loop showed lower accuracy (64%).
- These findings suggest that ST/HR recovery indices offer a valuable, albeit similar, alternative for diagnosing coronary artery disease.
Abstract:
This study assessed the diagnostic value of two new electrocardiographic criteria of coronary artery disease: the ST/HR index and the slope of the linear relationship between ST segment changes and the heart rate during the first three minutes of the post-exercise recovery period. These two criteria were compared to the standard criteria (> or = 1 mm horizontal or descending ST depression or > or = 2 mm ascending ST depression) to Detrano's ST/HR exercise index (> 1.6 microV/bpm in coronary patient), the exercise ST/HR slope (> or = 2.4 microV/bpm in coronary patients) and the exercise recovery loop (clockwise in normal and anticlockwise in coronary patients) in 88 subjects investigated for suspected coronary artery disease who underwent a computerised exercise stress test and coronary angiography (25 single vessel, 21 double vessel, 20 triple vessel disease; 22 with no significant coronary disease). The ROC identified thresholds of abnormality of the ST/HR recovery index at > or = 2.1 microV/bpm and of the ST/HR recovery slope at > or = 2.52 microV/bpm. Global comparison of the areas under the ROC showed the diagnostic superiority of the exercise ST/HR indices (0.96) over the standard criteria (0.92) and recovery indices (0.86) but without statistically significant values (p = 0.65 and p = 0.15 respectively). The ST/HR index and slope during recovery identify coronary disease with a diagnostic accuracy of 80% and 77% respectively which is similar to that (84%) of the standard ST criteria. The exercise-recovery loop was less accurate (64%).