Evaluation of the exercise electrocardiogram by the ST segment/heart rate slope.

A LTHOUGH for many years exercise electrocardiograms have been widely used for the evaluation of patients with suspected ischemic heart disease, standard electrocardiographic criteria have poor sensitivity for the detection of coronary artery disease and poor positive predictive value for coronary disease in populations with a low prevalence of coronary obstruction. 1-3 In addition, the clinical value of exercise electrocardiograms in patients with typical angina pectoris is limited by poor test accuracy for the identification of anatomically and functionally severe coronary disease.4'5 These problems, together with the significantly improved test sensitivity and specificity of methods based on radionuclide imaging,6 have reduced clinical confidence in the value of routine exercise electrocardiography for the assessment of the presence and severity of myocardial ischemia. Because the exercise electrocardiogram is available and easily accessible to most patients, improved test accuracy remains an important goal. It is therefore useful to review the clinical value and limitations of a recently developed physiologic approach to analysis of the exercise electrocardiogram that provides important insight into the nature and extent of underlying coronary disease.

[1]  P Kligfield,et al.  A modified treadmill exercise protocol for computer-assisted analysis of the ST segment/heart rate slope: methods and reproducibility. , 1986, Journal of electrocardiology.

[2]  L. Brasseur,et al.  Hemodynamic Determinants of Exercise ST‐Segment Depression in Coronary Patients , 1970, Circulation.

[3]  C. Martin,et al.  Maximal Treadmill Exercise Electrocardiography: Correlations with Coronary Arteriography and Cardiac Hemodynamics , 1972, Circulation.

[4]  M. Bertrand,et al.  Coronary sinus blood flow at rest and during isometric exercise in patients with aortic valve disease. Mechanism of angina pectoris in presence of normal coronary arteries. , 1981, The American journal of cardiology.

[5]  Y. Wang,et al.  Hemodynamic correlates of myocardial oxygen consumption during upright exercise. , 1972, Journal of applied physiology.

[6]  B R Chaitman,et al.  Improved Efficiency of Treadmill Exercise Testing Using a Multiple Lead ECG System and Basic Hemodynamic Exercise Response , 1978, Circulation.

[7]  J. Stoker,et al.  Accurate detection of coronary heart disease by new exercise test. , 1982, British heart journal.

[8]  P. Kligfield,et al.  Evaluation of coronary artery disease by an improved method of exercise electrocardiography: the ST segment/heart rate slope. , 1986, American heart journal.

[9]  W. Mays,et al.  Maximal exercise in children with aortic regurgitation: an adjunct to noninvasive assessment of disease severity. , 1984, American heart journal.

[10]  R. Finkelhor,et al.  The ST segment/heart rate slope as a predictor of coronary artery disease: comparison with quantitative thallium imaging and conventional ST segment criteria. , 1986, American heart journal.

[11]  P. Greenberg,et al.  Comparison of S-T segment changes on exercise testing with angiographic findings in patients with prior myocardial infarction. , 1978, The American journal of cardiology.

[12]  R. Balcon,et al.  Correlation of heart rate/ST slope and coronary angiographic findings. , 1984, British heart journal.

[13]  J. Stoker,et al.  Detection of severity of coronary artery disease by the ST segment/heart rate relationship in patients on beta-blocker therapy. , 1982, Cardiovascular research.

[14]  A. Selzer,et al.  Treadmill stress tests as indicators of presence and severity of coronary artery disease. , 1976, Annals of internal medicine.

[15]  K. Fox Exercise heart rate/ST segment relation. Perfect predictor of coronary disease. , 1982, British heart journal.

[16]  E. Böszörményi,et al.  Quantitative evaluation of exercise-induced ST-segment depression for estimation of degree of coronary artery disease. , 1984, European heart journal.

[17]  P. Malmberg,et al.  Qualitative and quantitative evaluation of the exercise electrocardiogram in assessing the degree of coronary heart disease. , 1985, Journal of electrocardiology.

[18]  P. Kligfield,et al.  Effects of recent and remote infarction on the predictive accuracy of the ST segment/heart rate slope. , 1986, Journal of the American College of Cardiology.

[19]  N. Goldschlager,et al.  Use of treadmill score to quantify ischemic response and predict extent of coronary disease. , 1979, Circulation.

[20]  G S Johnston,et al.  Sensitivity, Specificity and Predictive Accuracy of Radionuclide Cineangiography During Exercise in Patients with Coronary Artery Disease: Comparison with Exercise Electrocardiography , 1979, Circulation.

[21]  T. Ryan,et al.  Identification of patients with left main and three vessel coronary disease with clinical and exercise test variables. , 1980, The American journal of cardiology.

[22]  P. Kligfield,et al.  Improved accuracy of the exercise electrocardiogram: identification of three-vessel coronary disease in stable angina pectoris by analysis of peak rate-related changes in ST segments. , 1985, The American journal of cardiology.

[23]  A. M. Scher,et al.  Mechanism of S‐T Segment Alteration During Acute Myocardial Injury , 1960, Circulation research.

[24]  P. Kligfield,et al.  Predictive value and limitations of the ST/HR slope. , 1985, British heart journal.

[25]  A. Quyyumi,et al.  Inability of the ST segment/heart rate slope to predict accurately the severity of coronary artery disease. , 1984, British heart journal.

[26]  L. T. Sheffield,et al.  Relation of graded exercise test findings after myocardial infarction to extent of coronary artery disease and left ventricular dysfunction. , 1978, The American journal of cardiology.

[27]  R J Linden,et al.  Prediction of severity of coronary artery disease using slope of submaximal ST segment/heart rate relationship. , 1980, Cardiovascular research.