Document Detail

Heart rate adjustment of ST-segment depression for reduction of false positive electrocardiographic responses to exercise in asymptomatic men screened for coronary artery disease.
MedLine Citation:
PMID:  3189166     Owner:  NLM     Status:  MEDLINE    
The ability of heart rate (HR) correction of exercise-induced ST-segment depression (the delta ST/HR index) to reduce the number of false positive exercise electrocardiograms during initial screening for occult coronary artery disease (CAD) was examined in active, asymptomatic men from the Army Reserve. Among 606 consecutive men given treadmill tests, 62 asymptomatic subjects with normal results on resting electrocardiograms but abnormal outcomes on standard exercise electrocardiograms underwent rest and exercise radionuclide cineangiography, and the 10 subjects with abnormal radionuclide findings then underwent coronary angiography. A previously established delta ST/HR index less than 1.6 microV/beat/min correctly identified 34 of 52 subjects (65%) who, despite abnormal standard exercise electrocardiographic findings, had no rest or exercise radionuclide abnormalities. A delta ST/HR index greater than or equal to 1.6 microV/beta/min detected 7 of 7 subjects with abnormal radionuclide cineangiograms who had CAD at cardiac catheterization, but also identified 2 of 3 subjects with an abnormal radionuclide test who had no CAD. In contrast to the 7 of 62 subjects (11%) with abnormal standard exercise test criteria who had radionuclide and angiographic evidence of CAD, a delta ST/HR index partition of 1.6 microV/beat/min separated subjects into subgroups with 0% (0 of 35) vs 26% (7 of 27) prevalences of CAD by serial diagnostic evaluation (p less than 0.01). Thus, among asymptomatic subjects with abnormal electrocardiographic responses to exercise, simple HR correction of the magnitude of ST-segment depression reduced by 56% the number of subjects with standard exercise test criteria leading to referral for additional diagnostic evaluation, without loss of sensitivity for angiographically proven CAD and with accurate negative predictive value.(ABSTRACT TRUNCATED AT 250 WORDS)
P M Okin; P Kligfield; M R Milner; S A Goldstein; J Lindsay
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  The American journal of cardiology     Volume:  62     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  1988 Nov 
Date Detail:
Created Date:  1988-12-02     Completed Date:  1988-12-02     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1043-7     Citation Subset:  AIM; IM    
Department of Medicine, New York Hospital-Cornell Medical Center, New York 10021.
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MeSH Terms
Coronary Angiography
Coronary Disease / prevention & control*
Exercise Test
False Positive Reactions
Heart / radionuclide imaging
Heart Rate*
Mass Screening / methods*
Middle Aged
Risk Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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