The effect of resting ST segment depression on the diagnostic characteristics of the exercise treadmill test
OBJECTIVES The aim of this study is to demonstrate the effect of resting ST segment depression on the diagnostic characteristics of the exercise treadmill test. BACKGROUND Previous studies evaluating the effect of resting ST segment depression on the diagnostic characteristics of exercise treadmill...
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| Veröffentlicht in: | Journal of the American College of Cardiology 2000-04, Vol.35 (5), p.1206-1211 |
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| container_title | Journal of the American College of Cardiology |
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| creator | Fearon, William F Lee, David P Froelicher, Victor F |
| description | OBJECTIVES
The aim of this study is to demonstrate the effect of resting ST segment depression on the diagnostic characteristics of the exercise treadmill test.
BACKGROUND
Previous studies evaluating the effect of resting ST segment depression on the diagnostic characteristics of exercise treadmill test have been conducted on relatively small patient groups and based only on visual electrocardiogram (ECG) analysis.
METHODS
A retrospective analysis of data collected prospectively was performed on consecutive patients referred for evaluation of chest pain. One thousand two hundred eighty-two patients without a prior myocardial infarction underwent standard exercise treadmill tests followed by coronary angiography, with coronary artery disease defined as a 50% narrowing in at least one major epicardial coronary artery. Sensitivity, specificity, predictive accuracy and area under the curve of the receiver operating characteristic (ROC) plots were calculated for patients with and without resting ST segment depression as determined by visual or computerized analysis of the baseline ECG.
RESULTS
Sensitivity of the exercise treadmill test increased in 206 patients with resting ST segment depression determined by visual ECG analysis compared with patients without resting ST segment depression (77 ± 7% vs. 45 ± 4%) and specificity decreased (48 ± 12% vs. 84 ± 3%). With computerized analysis, sensitivity of the treadmill test increased in 349 patients with resting ST segment depression compared with patients without resting ST segment depression (71 ± 6% vs. 42 ± 4%) and specificity decreased (52 ± 9% vs. 87 ± 3%) (p < 0.0001 for all comparisons). There was no significant difference in the area under the curve of the ROC plots (0.66–0.69) or the predictive accuracy (62–68%) between the four subgroups.
CONCLUSIONS
The diagnostic accuracy and high sensitivity of the exercise treadmill test in a large cohort of patients with resting ST segment depression and no prior myocardial infarction support the initial use of the test for diagnosis of coronary artery disease. The classification of resting ST segment depression by method of analysis (visual vs. computerized) did not affect the results. |
| doi_str_mv | 10.1016/S0735-1097(00)00518-0 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_71027056</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0735109700005180</els_id><sourcerecordid>71027056</sourcerecordid><originalsourceid>FETCH-LOGICAL-c425t-57ab70001cf81c1adf9ea6bf61f5000f65bf0b5491d289b989f7290a3de8527e3</originalsourceid><addsrcrecordid>eNqFkc1KLDEQRoMoOld9BCULkeuitdI96XRWIsO9KgguHNchnVTGSP-MSY_o25t2BnUnBEKKU18VJ4QcMThnwMqLBxAFzxhI8RfgDICzKoMtMmGcV1nBpdgmky9kj_yJ8RkAyorJXbLHQPBKlvmENPMnpOgcmoH2jgaMg-8W9GFOIy5a7AZqcZmq0fcdTWdIuPV60fUJNNQ86aDNgMGPzzhGjAS-YTA-Ih0Catv6pqFDSj4gO043EQ839z55_P9vPrvJ7u6vb2dXd5mZ5nzIuNC1SMsy4ypmmLZOoi5rVzLHU9mVvHZQ86lkNq9kLSvpRC5BFxYrngss9snpOncZ-pdVGqxaHw02je6wX0UlGOQCeJlAvgZN6GMM6NQy-FaHd8VAjZrVp2Y1OlQA6lOzgtR3vBmwqlu0P7rWXhNwsgF0NLpxQXfJxzdXMD6dyoRdrjFMNl49BhWNx86g9SH9iLK9_2WTDzeFmnM</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>71027056</pqid></control><display><type>article</type><title>The effect of resting ST segment depression on the diagnostic characteristics of the exercise treadmill test</title><source>MEDLINE</source><source>ScienceDirect Journals (5 years ago - present)</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Fearon, William F ; Lee, David P ; Froelicher, Victor F</creator><creatorcontrib>Fearon, William F ; Lee, David P ; Froelicher, Victor F</creatorcontrib><description>OBJECTIVES
The aim of this study is to demonstrate the effect of resting ST segment depression on the diagnostic characteristics of the exercise treadmill test.
BACKGROUND
Previous studies evaluating the effect of resting ST segment depression on the diagnostic characteristics of exercise treadmill test have been conducted on relatively small patient groups and based only on visual electrocardiogram (ECG) analysis.
METHODS
A retrospective analysis of data collected prospectively was performed on consecutive patients referred for evaluation of chest pain. One thousand two hundred eighty-two patients without a prior myocardial infarction underwent standard exercise treadmill tests followed by coronary angiography, with coronary artery disease defined as a 50% narrowing in at least one major epicardial coronary artery. Sensitivity, specificity, predictive accuracy and area under the curve of the receiver operating characteristic (ROC) plots were calculated for patients with and without resting ST segment depression as determined by visual or computerized analysis of the baseline ECG.
RESULTS
Sensitivity of the exercise treadmill test increased in 206 patients with resting ST segment depression determined by visual ECG analysis compared with patients without resting ST segment depression (77 ± 7% vs. 45 ± 4%) and specificity decreased (48 ± 12% vs. 84 ± 3%). With computerized analysis, sensitivity of the treadmill test increased in 349 patients with resting ST segment depression compared with patients without resting ST segment depression (71 ± 6% vs. 42 ± 4%) and specificity decreased (52 ± 9% vs. 87 ± 3%) (p < 0.0001 for all comparisons). There was no significant difference in the area under the curve of the ROC plots (0.66–0.69) or the predictive accuracy (62–68%) between the four subgroups.
CONCLUSIONS
The diagnostic accuracy and high sensitivity of the exercise treadmill test in a large cohort of patients with resting ST segment depression and no prior myocardial infarction support the initial use of the test for diagnosis of coronary artery disease. The classification of resting ST segment depression by method of analysis (visual vs. computerized) did not affect the results.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/S0735-1097(00)00518-0</identifier><identifier>PMID: 10758962</identifier><identifier>CODEN: JACCDI</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Biological and medical sciences ; Cardiology. Vascular system ; Chest Pain - etiology ; Coronary Angiography ; Coronary Disease - classification ; Coronary Disease - complications ; Coronary Disease - diagnosis ; Coronary heart disease ; Data Interpretation, Statistical ; Diabetes Complications ; Electrocardiography - standards ; Exercise Test - standards ; Heart ; Humans ; Hypercholesterolemia - complications ; Hypertension - complications ; Male ; Medical sciences ; Middle Aged ; Reproducibility of Results ; Retrospective Studies ; Risk Factors ; Sensitivity and Specificity ; Signal Processing, Computer-Assisted ; Smoking - adverse effects</subject><ispartof>Journal of the American College of Cardiology, 2000-04, Vol.35 (5), p.1206-1211</ispartof><rights>2000 American College of Cardiology</rights><rights>2000 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c425t-57ab70001cf81c1adf9ea6bf61f5000f65bf0b5491d289b989f7290a3de8527e3</citedby><cites>FETCH-LOGICAL-c425t-57ab70001cf81c1adf9ea6bf61f5000f65bf0b5491d289b989f7290a3de8527e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/S0735-1097(00)00518-0$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3549,27923,27924,45994</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1315449$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10758962$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fearon, William F</creatorcontrib><creatorcontrib>Lee, David P</creatorcontrib><creatorcontrib>Froelicher, Victor F</creatorcontrib><title>The effect of resting ST segment depression on the diagnostic characteristics of the exercise treadmill test</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>OBJECTIVES
The aim of this study is to demonstrate the effect of resting ST segment depression on the diagnostic characteristics of the exercise treadmill test.
BACKGROUND
Previous studies evaluating the effect of resting ST segment depression on the diagnostic characteristics of exercise treadmill test have been conducted on relatively small patient groups and based only on visual electrocardiogram (ECG) analysis.
METHODS
A retrospective analysis of data collected prospectively was performed on consecutive patients referred for evaluation of chest pain. One thousand two hundred eighty-two patients without a prior myocardial infarction underwent standard exercise treadmill tests followed by coronary angiography, with coronary artery disease defined as a 50% narrowing in at least one major epicardial coronary artery. Sensitivity, specificity, predictive accuracy and area under the curve of the receiver operating characteristic (ROC) plots were calculated for patients with and without resting ST segment depression as determined by visual or computerized analysis of the baseline ECG.
RESULTS
Sensitivity of the exercise treadmill test increased in 206 patients with resting ST segment depression determined by visual ECG analysis compared with patients without resting ST segment depression (77 ± 7% vs. 45 ± 4%) and specificity decreased (48 ± 12% vs. 84 ± 3%). With computerized analysis, sensitivity of the treadmill test increased in 349 patients with resting ST segment depression compared with patients without resting ST segment depression (71 ± 6% vs. 42 ± 4%) and specificity decreased (52 ± 9% vs. 87 ± 3%) (p < 0.0001 for all comparisons). There was no significant difference in the area under the curve of the ROC plots (0.66–0.69) or the predictive accuracy (62–68%) between the four subgroups.
CONCLUSIONS
The diagnostic accuracy and high sensitivity of the exercise treadmill test in a large cohort of patients with resting ST segment depression and no prior myocardial infarction support the initial use of the test for diagnosis of coronary artery disease. The classification of resting ST segment depression by method of analysis (visual vs. computerized) did not affect the results.</description><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Chest Pain - etiology</subject><subject>Coronary Angiography</subject><subject>Coronary Disease - classification</subject><subject>Coronary Disease - complications</subject><subject>Coronary Disease - diagnosis</subject><subject>Coronary heart disease</subject><subject>Data Interpretation, Statistical</subject><subject>Diabetes Complications</subject><subject>Electrocardiography - standards</subject><subject>Exercise Test - standards</subject><subject>Heart</subject><subject>Humans</subject><subject>Hypercholesterolemia - complications</subject><subject>Hypertension - complications</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Reproducibility of Results</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Sensitivity and Specificity</subject><subject>Signal Processing, Computer-Assisted</subject><subject>Smoking - adverse effects</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc1KLDEQRoMoOld9BCULkeuitdI96XRWIsO9KgguHNchnVTGSP-MSY_o25t2BnUnBEKKU18VJ4QcMThnwMqLBxAFzxhI8RfgDICzKoMtMmGcV1nBpdgmky9kj_yJ8RkAyorJXbLHQPBKlvmENPMnpOgcmoH2jgaMg-8W9GFOIy5a7AZqcZmq0fcdTWdIuPV60fUJNNQ86aDNgMGPzzhGjAS-YTA-Ih0Catv6pqFDSj4gO043EQ839z55_P9vPrvJ7u6vb2dXd5mZ5nzIuNC1SMsy4ypmmLZOoi5rVzLHU9mVvHZQ86lkNq9kLSvpRC5BFxYrngss9snpOncZ-pdVGqxaHw02je6wX0UlGOQCeJlAvgZN6GMM6NQy-FaHd8VAjZrVp2Y1OlQA6lOzgtR3vBmwqlu0P7rWXhNwsgF0NLpxQXfJxzdXMD6dyoRdrjFMNl49BhWNx86g9SH9iLK9_2WTDzeFmnM</recordid><startdate>20000401</startdate><enddate>20000401</enddate><creator>Fearon, William F</creator><creator>Lee, David P</creator><creator>Froelicher, Victor F</creator><general>Elsevier Inc</general><general>Elsevier Science</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20000401</creationdate><title>The effect of resting ST segment depression on the diagnostic characteristics of the exercise treadmill test</title><author>Fearon, William F ; Lee, David P ; Froelicher, Victor F</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c425t-57ab70001cf81c1adf9ea6bf61f5000f65bf0b5491d289b989f7290a3de8527e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2000</creationdate><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Chest Pain - etiology</topic><topic>Coronary Angiography</topic><topic>Coronary Disease - classification</topic><topic>Coronary Disease - complications</topic><topic>Coronary Disease - diagnosis</topic><topic>Coronary heart disease</topic><topic>Data Interpretation, Statistical</topic><topic>Diabetes Complications</topic><topic>Electrocardiography - standards</topic><topic>Exercise Test - standards</topic><topic>Heart</topic><topic>Humans</topic><topic>Hypercholesterolemia - complications</topic><topic>Hypertension - complications</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Reproducibility of Results</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Sensitivity and Specificity</topic><topic>Signal Processing, Computer-Assisted</topic><topic>Smoking - adverse effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fearon, William F</creatorcontrib><creatorcontrib>Lee, David P</creatorcontrib><creatorcontrib>Froelicher, Victor F</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fearon, William F</au><au>Lee, David P</au><au>Froelicher, Victor F</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The effect of resting ST segment depression on the diagnostic characteristics of the exercise treadmill test</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2000-04-01</date><risdate>2000</risdate><volume>35</volume><issue>5</issue><spage>1206</spage><epage>1211</epage><pages>1206-1211</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><coden>JACCDI</coden><abstract>OBJECTIVES
The aim of this study is to demonstrate the effect of resting ST segment depression on the diagnostic characteristics of the exercise treadmill test.
BACKGROUND
Previous studies evaluating the effect of resting ST segment depression on the diagnostic characteristics of exercise treadmill test have been conducted on relatively small patient groups and based only on visual electrocardiogram (ECG) analysis.
METHODS
A retrospective analysis of data collected prospectively was performed on consecutive patients referred for evaluation of chest pain. One thousand two hundred eighty-two patients without a prior myocardial infarction underwent standard exercise treadmill tests followed by coronary angiography, with coronary artery disease defined as a 50% narrowing in at least one major epicardial coronary artery. Sensitivity, specificity, predictive accuracy and area under the curve of the receiver operating characteristic (ROC) plots were calculated for patients with and without resting ST segment depression as determined by visual or computerized analysis of the baseline ECG.
RESULTS
Sensitivity of the exercise treadmill test increased in 206 patients with resting ST segment depression determined by visual ECG analysis compared with patients without resting ST segment depression (77 ± 7% vs. 45 ± 4%) and specificity decreased (48 ± 12% vs. 84 ± 3%). With computerized analysis, sensitivity of the treadmill test increased in 349 patients with resting ST segment depression compared with patients without resting ST segment depression (71 ± 6% vs. 42 ± 4%) and specificity decreased (52 ± 9% vs. 87 ± 3%) (p < 0.0001 for all comparisons). There was no significant difference in the area under the curve of the ROC plots (0.66–0.69) or the predictive accuracy (62–68%) between the four subgroups.
CONCLUSIONS
The diagnostic accuracy and high sensitivity of the exercise treadmill test in a large cohort of patients with resting ST segment depression and no prior myocardial infarction support the initial use of the test for diagnosis of coronary artery disease. The classification of resting ST segment depression by method of analysis (visual vs. computerized) did not affect the results.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>10758962</pmid><doi>10.1016/S0735-1097(00)00518-0</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of the American College of Cardiology, 2000-04, Vol.35 (5), p.1206-1211 |
| issn | 0735-1097 1558-3597 |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Biological and medical sciences Cardiology. Vascular system Chest Pain - etiology Coronary Angiography Coronary Disease - classification Coronary Disease - complications Coronary Disease - diagnosis Coronary heart disease Data Interpretation, Statistical Diabetes Complications Electrocardiography - standards Exercise Test - standards Heart Humans Hypercholesterolemia - complications Hypertension - complications Male Medical sciences Middle Aged Reproducibility of Results Retrospective Studies Risk Factors Sensitivity and Specificity Signal Processing, Computer-Assisted Smoking - adverse effects |
| title | The effect of resting ST segment depression on the diagnostic characteristics of the exercise treadmill test |
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