Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1977 Feb;39(2):212–217. doi: 10.1136/hrt.39.2.212

Clinical value of quantitative analysis of ST slope during exercise.

C A Ascoop, C A Distelbrink, P A De Lang
PMCID: PMC483219  PMID: 319813

Abstract

The diagnostic performance of automatic analysis of the exercise electrocardiogram in detecting ischaemic heart disease was studied in 147 patients with angiographically documented coronary disease. The results were compared with the results of visual analysis of the same recordings. Using a bicycle ergometer we tried to reach at least 90 per cent of the predicted maximal heart rate of the patient. Two bipolar thoracic leads (CM5, CC5) were used. In the visual analysis the criterion of the so-called ischaemic ST segment was applied. For the automatic analysis the population was divided into a learning group (N=87) and a testing group (N=60). In the learning group first critical values were computed for different ST measurements that provided optimal separation between patients with (CAG POS.) and without (CAG. NEG.) significant coronary stenoses as revealed by coronary arteriography. These critical values were kept unchanged when applied to the testing group. With respect to the visual method an increase of the sensitivity by 0-45 and 0-36 was obtained by the automatic analysis in the learning and testing group, respectively. The best separation between CAG. POS. and CAG. NEG. group was reached using a criterion consisting of a linear combination of the slope of the initial part of the ST segment and the ST depression; the sensitivity being 0-70 and 0-60, respectively, in the learning and testing group. Using a criterion based on the area between the baseline and the ST segment (the SX integral) these values were 0-42 and 0-49, respectively. All specificities were kept to at least 0-90.

Full text

PDF
212

Selected References

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

  1. Ascoop C. A., Simoons M. L., Egmond W. G., Bruschke A. V. Exercise test, history, and serum lipid levels in patients with chest pain and normal electrocardiogram at rest: comparison to findings at coronary arteriography. Am Heart J. 1971 Nov;82(5):609–617. doi: 10.1016/0002-8703(71)90329-2. [DOI] [PubMed] [Google Scholar]
  2. BURGER H. C., van BRUMMELEN A., van HERPEN Compromise in vectorcardiography. II. Alterations of coefficients as a means of adapting one lead system to another. Subjective and mathematical comparison of four systems of VCG. Am Heart J. 1962 Nov;64:666–678. doi: 10.1016/0002-8703(62)90252-1. [DOI] [PubMed] [Google Scholar]
  3. Bartel A. G., Behar V. S., Peter R. H., Orgain E. S., Kong Y. Graded exercise stress tests in angiographically documented coronary artery disease. Circulation. 1974 Feb;49(2):348–356. doi: 10.1161/01.cir.49.2.348. [DOI] [PubMed] [Google Scholar]
  4. Distelbrink C. A., Ascoop C. A., de Lang P. A. The diagnostic value of exercise electrocardiograms. Adv Cardiol. 1976;16:529–533. doi: 10.1159/000398454. [DOI] [PubMed] [Google Scholar]
  5. Ellestad M. H., Wan M. K. Predictive implications of stress testing. Follow-up of 2700 subjects after maximum treadmill stress testing. Circulation. 1975 Feb;51(2):363–369. doi: 10.1161/01.cir.51.2.363. [DOI] [PubMed] [Google Scholar]
  6. 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]
  7. McConahay D. R., McCallister B. D., Hallermann F. J., Smith R. E. Comparative quantitative analysis of the electrocardiogram and the vectorcardiogram. Correlations with the coronary arteriogram. Circulation. 1970 Aug;42(2):245–259. doi: 10.1161/01.cir.42.2.245. [DOI] [PubMed] [Google Scholar]
  8. McHenry P. L., Phillips J. F., Knoebel S. B. Correlation of computer-quantitated treadmill exercise electrocardiogram with arteriographic location of coronary artery disease. Am J Cardiol. 1972 Nov;30(7):747–752. doi: 10.1016/0002-9149(72)90149-x. [DOI] [PubMed] [Google Scholar]
  9. Punsar S., Pyöräla K., Siltanen P. Classification of electrocardiographic S-T segment changes in epidemiological studies of coronary heart disease. Preliminary evaluation of a new, modified classification, with particular reference to the prognostic significance of different types of S-T segment changes. Ann Med Intern Fenn. 1968;57(2):53–63. [PubMed] [Google Scholar]
  10. Roman L., Bellet S. Significance of the QX-QT ratio and the QT ratio (QTr) in the exercise electrocardiogram. Circulation. 1965 Sep;32(3):435–437. doi: 10.1161/01.cir.32.3.435. [DOI] [PubMed] [Google Scholar]
  11. SHEFFIELD L. T., REEVES T. J. GRADED EXERCISE IN THE DIAGNOSIS OF ANGINA PECTORIS. Mod Concepts Cardiovasc Dis. 1965 Jan;34:1–6. [PubMed] [Google Scholar]
  12. SONES F. M., Jr, SHIREY E. K. Cine coronary arteriography. Mod Concepts Cardiovasc Dis. 1962 Jul;31:735–738. [PubMed] [Google Scholar]
  13. Sheffield L. T., Holt J. H., Lester F. M., Conroy D. V., Reeves T. J. On-line analysis of the exercise electrocardiogram. Circulation. 1969 Dec;40(6):935–944. doi: 10.1161/01.cir.40.6.935. [DOI] [PubMed] [Google Scholar]
  14. Yanowitz F., Froelicher V. F., Jr, Keiser N., Lancaster M. C. Quantitative exercise electrocardiography in the evaluation of patients with early coronary artery disease. Aerosp Med. 1974 Apr;45(4):443–448. [PubMed] [Google Scholar]
  15. van Bemmel J. H., Talmon J. L., Duisterhout J. S., Hengeveld S. J. Template waveform recognition applied to ECG-VCG analysis. Comput Biomed Res. 1973 Oct;6(5):430–441. doi: 10.1016/0010-4809(73)90076-1. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES