Document Detail


Improved exercise test accuracy using discriminant function analysis and "recovery ST slope".
MedLine Citation:
PMID:  8409814     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The objective of the study was to optimize the accuracy of the exercise test for predicting the presence of significant angiographic coronary artery disease. A retrospective analysis of stored digital exercise electrocardiographic data on 147 men who had undergone exercise testing and cardiac catheterization was performed. With significant coronary artery disease defined as > or = 70% stenosis, 95 patients had one or more vessel(s) diseased. None were receiving digoxin, had a myocardial infarction or previous coronary artery bypass graft, or exhibited left bundle branch block, left ventricular hypertrophy, Q waves, or ST depression on their resting electrocardiogram. Analysis was performed using the authors' averaging and measurement software at rest and at each 30 seconds throughout the exercise and recovery in leads II, V2, and V5. Discriminant function analysis was used to analyze pretest variables, as well as hemodynamic and electrocardiographic changes and symptoms during exercise. A discriminant function score was developed and compared to other treadmill scores. The setting was a 1,000 bed Veterans Affairs Medical Center (Long Beach, CA). Discriminant function analysis chose age, smoking status, presenting chest pain characteristics, and lead V5 ST slope in recovery to have independent power for separating those with and without coronary artery disease. A discriminant function score using these four variables was used to form a receiver operating characteristics curve (and derive receiver operating characteristics curve areas) for comparison to other exercise test methods and scores: (discriminant function score = .81; slope 3.5 minutes into recovery in lead V5 = .73; traditional ST amplitude method = .72; ST60/HR index (amplitude of ST depression 60 ms after the J point/delta heart rate) = .66; traditional ST amplitude/HR index (traditional method/delta heart rate) = .75; Hollenberg score = .68; Hollenberg areas only = .66; and ST integral = .66. Receiver operating characteristics curve analysis revealed a trend for the discriminant function score to be superior to all other measurements and scores. Recovery ST slope in lead V5 performed as well as or better than all other electrocardiographic criteria or treadmill scores except for the authors' discriminant function score.
Authors:
M Rodriguez; I Moussa; J Froning; M Kochumian; V F Froelicher
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of electrocardiology     Volume:  26     ISSN:  0022-0736     ISO Abbreviation:  J Electrocardiol     Publication Date:  1993 Jul 
Date Detail:
Created Date:  1993-11-02     Completed Date:  1993-11-02     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0153605     Medline TA:  J Electrocardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  207-18     Citation Subset:  IM    
Affiliation:
Cardiology Department, Long Beach Veterans Affairs Medical Center, California 90822.
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MeSH Terms
Descriptor/Qualifier:
Coronary Angiography
Coronary Disease / diagnosis,  radiography
Discriminant Analysis
Electrocardiography*
Exercise Test*
Heart Catheterization
Humans
Male
Middle Aged
Predictive Value of Tests
ROC Curve
Retrospective Studies
Sensitivity and Specificity

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


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