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. 1982 Oct;48(4):311–320. doi: 10.1136/hrt.48.4.311

Accurate detection of coronary heart disease by new exercise test.

M S Elamin, R Boyle, M M Kardash, D R Smith, J B Stoker, W Whitaker, D A Mary, R J Linden
PMCID: PMC481255  PMID: 6127094

Abstract

The ability of a new exercise test accurately to detect the presence and severity of coronary heart disease has been examined in 206 patients with anginal pain, including patients on beta blockers or with concomitant cardiac lesions. From recordings of 13 electrocardiographic leads during exercise, the maximal rate of progression of ST segment depression relative to increased in heart rate (maximal ST/HR slope) was obtained and used as an index of myocardial ischaemia. The maximal ST/HR slope and results of coronary arteriography were independently obtained and the two sets of data compared the ranges of the maximal ST/HR slopes in the 38 patients with no significant disease, 49 with single vessel, 75 with double vessel, and 44 patients with triple vessel disease were different from each other and there was no overlap in the data between adjacent groups; there were no false positive, false negative, or indeterminate results. It is concluded that the maximal ST/HR slope can be used reliably to predict the presence of absence and severity of coronary heart disease in individual patients presenting with anginal pain in a hospital population.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adams D. F., Fraser D. B., Abrams H. L. The complications of coronary arteriography. Circulation. 1973 Sep;48(3):609–618. doi: 10.1161/01.cir.48.3.609. [DOI] [PubMed] [Google Scholar]
  2. Angell C. S., Lakatta E. G., Weisfeldt M. L., Shock N. W. Relationship of intramyocardial oxygen tension and epicardial ST segment changes following acute coronary artery ligation: effects of coronary perfusion pressure. Cardiovasc Res. 1975 Jan;9(1):12–18. doi: 10.1093/cvr/9.1.12. [DOI] [PubMed] [Google Scholar]
  3. Baron D. W., Poole-Wilson P. A., Rickards A. F. Maximal 12-lead exercise testing for prediction of severity of coronary artery disease. Eur J Cardiol. 1980;11(4):259–267. [PubMed] [Google Scholar]
  4. Becker L. C., Ferreira R., Thomas M. Mapping of left ventricular blood flow with radioactive microspheres in experimental coronary artery occlusion. Cardiovasc Res. 1973 May;7(3):391–400. doi: 10.1093/cvr/7.3.391. [DOI] [PubMed] [Google Scholar]
  5. Berman J. L., Wynne J., Cohn P. F. A multivariate approach for interpreting treadmill exercise tests in coronary artery disease. Circulation. 1978 Sep;58(3 Pt 1):505–512. doi: 10.1161/01.cir.58.3.505. [DOI] [PubMed] [Google Scholar]
  6. Bruschke A. V., Wijers T. S., Kolsters W., Landmann J. The anatomic evolution of coronary artery disease demonstrated by coronary arteriography in 256 nonoperated patients. Circulation. 1981 Mar;63(3):527–536. doi: 10.1161/01.cir.63.3.527. [DOI] [PubMed] [Google Scholar]
  7. Chaitman B. R., Bourassa M. G., Wagniart P., Corbara F., Ferguson R. J. Improved efficiency of treadmill exercise testing using a multiple lead ECG system and basic hemodynamic exercise response. Circulation. 1978 Jan;57(1):71–79. doi: 10.1161/01.cir.57.1.71. [DOI] [PubMed] [Google Scholar]
  8. Chaitman B. R., Waters D. D., Bourassa M. G., Tubau J. F., Wagniart P., Ferguson R. J. The importance of clinical subsets in interpreting maximal treadmill exercise test results: the role of multiple-lead ECG systems. Circulation. 1979 Mar;59(3):560–570. doi: 10.1161/01.cir.59.3.560. [DOI] [PubMed] [Google Scholar]
  9. Diamond G. A., Forrester J. S. Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med. 1979 Jun 14;300(24):1350–1358. doi: 10.1056/NEJM197906143002402. [DOI] [PubMed] [Google Scholar]
  10. EKMEKCI A., TOYOSHIMA H., KWOCZYNSKI J. K., NAGAYA T., PRINZMETAL M. Angina pectoris. IV. Clinical and experimental difference between ischemia with S-T elevation and ischemia with S-T depression. Am J Cardiol. 1961 Mar;7:412–426. doi: 10.1016/0002-9149(61)90485-4. [DOI] [PubMed] [Google Scholar]
  11. Elamin M. S., Mary D. A., Smith D. R., Linden R. J. Prediction of severity of coronary artery disease using slope of submaximal ST segment/heart rate relationship. Cardiovasc Res. 1980 Dec;14(12):681–691. doi: 10.1093/cvr/14.12.681. [DOI] [PubMed] [Google Scholar]
  12. Ellestad M. H., Cooke B. M., Jr, Greenberg P. S. Stress testing: clinical application and predictive capacity. Prog Cardiovasc Dis. 1979 May-Jun;21(6):431–460. doi: 10.1016/0033-0620(79)90025-2. [DOI] [PubMed] [Google Scholar]
  13. Erikssen J., Enge I., Forfang K., Storstein O. False positive diagnostic tests and coronary angiographic findings in 105 presumably healthy males. Circulation. 1976 Sep;54(3):371–376. doi: 10.1161/01.cir.54.3.371. [DOI] [PubMed] [Google Scholar]
  14. Folts J. D., Gallagher K., Rowe G. G. Hemodynamic effects of controlled degrees of coronary artery stenosis in short-term and long-term studies in dogs. J Thorac Cardiovasc Surg. 1977 May;73(5):722–727. [PubMed] [Google Scholar]
  15. Fortuin N. J., Weiss J. L. Exercise stress testing. Circulation. 1977 Nov;56(5):699–712. doi: 10.1161/01.cir.56.5.699. [DOI] [PubMed] [Google Scholar]
  16. Froelicher V. F., Jr, Yanowitz F. G., Thompson A. J., Lancaster M. C. The correlation of coronary angiography and the electrocardiographic response to maximal treadmill testing in 76 asymptomatic men. Circulation. 1973 Sep;48(3):597–604. doi: 10.1161/01.cir.48.3.597. [DOI] [PubMed] [Google Scholar]
  17. Geary G. G., Smith G. T., McNamara J. J. Defining the anatomic perfusion bed of an occluded coronary artery and the region at risk to infarction. A comparative study in the baboon, pig and dog. Am J Cardiol. 1981 Jun;47(6):1240–1247. doi: 10.1016/0002-9149(81)90253-8. [DOI] [PubMed] [Google Scholar]
  18. Gerry J. L., Jr, Schaff H. V., Kallman C. H., Flaherty J. T. Effects of nitroglycerin on regional myocardial ischemia induced by atrial pacing in dogs. Circ Res. 1981 Apr;48(4):569–576. doi: 10.1161/01.res.48.4.569. [DOI] [PubMed] [Google Scholar]
  19. Gianelly R. E., Treister B. L., Harrison D. C. The effect of propranolol on exercise-induced ischemic S-T segment depression. Am J Cardiol. 1969 Aug;24(2):161–165. doi: 10.1016/0002-9149(69)90398-1. [DOI] [PubMed] [Google Scholar]
  20. Gobel F. L., Norstrom L. A., Nelson R. R., Jorgensen C. R., Wang Y. The rate-pressure product as an index of myocardial oxygen consumption during exercise in patients with angina pectoris. Circulation. 1978 Mar;57(3):549–556. doi: 10.1161/01.cir.57.3.549. [DOI] [PubMed] [Google Scholar]
  21. Goodwin J. F. Recommending coronary artery surgery: refining judgement through application of new knowledge. Postgrad Med J. 1976 Dec;52(614):782–787. doi: 10.1136/pgmj.52.614.782. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Gould K. L., Lipscomb K., Calvert C. Compensatory changes of the distal coronary vascular bed during progressive coronary constriction. Circulation. 1975 Jun;51(6):1085–1094. doi: 10.1161/01.cir.51.6.1085. [DOI] [PubMed] [Google Scholar]
  23. Guyton R. A., McClenathan J. H., Newman G. E., Michaelis L. L. Significance of subendocardial S-T segment elevation caused by coronary stenosis in the dog. Epicardial S-T segment depression, local ischemia and subsequent necrosis. Am J Cardiol. 1977 Sep;40(3):373–380. doi: 10.1016/0002-9149(77)90159-x. [DOI] [PubMed] [Google Scholar]
  24. Harris C. N., Aronow W. S., Parker D. P., Kaplan M. A. Treadmill stress test in left ventricular hypertrophy. Chest. 1973 Mar;63(3):353–357. doi: 10.1378/chest.63.3.353. [DOI] [PubMed] [Google Scholar]
  25. Hoffman J. I. Why is myocardial ischaemia so commonly subendocardial? Clin Sci (Lond) 1981 Dec;61(6):657–662. doi: 10.1042/cs0610657. [DOI] [PubMed] [Google Scholar]
  26. Holmberg S., Varnauskas E. Coronary circulation during pacing-induced tachycardia. Acta Med Scand. 1971 Dec;190(6):481–490. doi: 10.1111/j.0954-6820.1971.tb07463.x. [DOI] [PubMed] [Google Scholar]
  27. Khouri E. M., Gregg D. E., Rayford C. R. Effect of exercise on cardiac output, left coronary flow and myocardial metabolism in the unanesthetized dog. Circ Res. 1965 Nov;17(5):427–437. doi: 10.1161/01.res.17.5.427. [DOI] [PubMed] [Google Scholar]
  28. Khuri S. F., Flaherty J. T., O'Riordan J. B., Pitt B., Brawley R. K., Donahoo J. S., Gott V. L. Changes in intramyocardial ST segment voltage and gas tensions with regional myocardial ischemia in the dog. Circ Res. 1975 Oct;37(4):455–463. doi: 10.1161/01.res.37.4.455. [DOI] [PubMed] [Google Scholar]
  29. Klocke F. J., Ellis A. K. Control of coronary blood flow. Annu Rev Med. 1980;31:489–508. doi: 10.1146/annurev.me.31.020180.002421. [DOI] [PubMed] [Google Scholar]
  30. Lassvik C. Reproducibility of work performance at serial exercises in patients with angina pectoris. Scand J Clin Lab Invest. 1978 Dec;38(8):747–751. doi: 10.1080/00365517809104882. [DOI] [PubMed] [Google Scholar]
  31. Linhart J. W., Turnoff H. B. Maximum treadmill exercise test in patients with abnormal control electrocardiograms. Circulation. 1974 Apr;49(4):667–672. doi: 10.1161/01.cir.49.4.667. [DOI] [PubMed] [Google Scholar]
  32. Logan S. E. On the fluid mechanics of human coronary artery stenosis. IEEE Trans Biomed Eng. 1975 Jul;22(4):327–334. doi: 10.1109/tbme.1975.324453. [DOI] [PubMed] [Google Scholar]
  33. Mason R. E., Likar I., Biern R. O., Ross R. S. Multiple-lead exercise electrocardiography. Experience in 107 normal subjects and 67 patients with angina pectoris, and comparison with coronary cinearteriography in 84 patients. Circulation. 1967 Oct;36(4):517–525. doi: 10.1161/01.cir.36.4.517. [DOI] [PubMed] [Google Scholar]
  34. Nixon J. V., Lipscomb K., Blomqvist C. G., Shapiro W. Exercise testing in men with significant left main coronary disease. Br Heart J. 1979 Oct;42(4):410–415. doi: 10.1136/hrt.42.4.410. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Pitt B., Gregg D. E. Coronary hemodynamic effects of increasing ventricular rate in the unanesthetized dog. Circ Res. 1968 Jun;22(6):753–761. doi: 10.1161/01.res.22.6.753. [DOI] [PubMed] [Google Scholar]
  36. Raffo J. A., Luksic I. Y., Kappagoda C. T., Mary D. A., Stoker J. B., Whitaker W., Linden R. J. Diagnostic value of routine exercise testing in hospital patients with angina pectoris. Br Med J. 1979 Aug 4;2(6185):295–297. doi: 10.1136/bmj.2.6185.295. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Roitman D., Jones W. B., Sheffield L. T. Comparison of submaximal exercise ECG test with coronary cineangiocardiogram. Ann Intern Med. 1970 May;72(5):641–647. doi: 10.7326/0003-4819-72-5-641. [DOI] [PubMed] [Google Scholar]
  38. SAYEN J. J., SHELDON W. F., PEIRCE G., KUO P. T. Polarographic oxygen, the epicardial electrocardiogram and muscle contraction in experimental acute regional ischemia of the left ventricle. Circ Res. 1958 Nov;6(6):779–798. doi: 10.1161/01.res.6.6.779. [DOI] [PubMed] [Google Scholar]
  39. Smith S. C., Jr, Gorlin R., Herman M. V., Taylor W. J., Collins J. J., Jr Myocardial blood flow in man: effects of coronary collateral circulation and coronary artery bypass surgery. J Clin Invest. 1972 Oct;51(10):2556–2565. doi: 10.1172/JCI107072. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Sonnenblick E. H., Ross J., Jr, Braunwald E. Oxygen consumption of the heart. Newer concepts of its multifactoral determination. Am J Cardiol. 1968 Sep;22(3):328–336. doi: 10.1016/0002-9149(68)90117-3. [DOI] [PubMed] [Google Scholar]
  41. Tucker S. C., Kemp V. E., Holland W. E., Horgan J. H. Multiple lead ECG submaximal treadmill exercise tests in angiographically documented coronary heart disease. Angiology. 1976 Mar;27(3):149–156. doi: 10.1177/000331977602700302. [DOI] [PubMed] [Google Scholar]
  42. Vatner S. F., Baig H., Manders W. T., Ochs H., Pagani M. Effects of propranolol on regional myocardial function, electrograms, and blood flow in conscious dogs with myocardial ischemia. J Clin Invest. 1977 Aug;60(2):353–360. doi: 10.1172/JCI108783. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Weiner D. A., McCabe C., Hueter D. C., Ryan T. J., Hood W. B., Jr The predictive value of anginal chest pain as an indicator of coronary disease during exercise testing. Am Heart J. 1978 Oct;96(4):458–462. doi: 10.1016/0002-8703(78)90155-2. [DOI] [PubMed] [Google Scholar]
  44. Weiner D. A., Ryan T. J., McCabe C. H., Kennedy J. W., Schloss M., Tristani F., Chaitman B. R., Fisher L. D. Exercise stress testing. Correlations among history of angina, ST-segment response and prevalence of coronary-artery disease in the Coronary Artery Surgery Study (CASS). N Engl J Med. 1979 Aug 2;301(5):230–235. doi: 10.1056/NEJM197908023010502. [DOI] [PubMed] [Google Scholar]

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