ST-segment depression on resting electrocardiogram in patients with out prior cardiac disease — a comparison with stress electrocardiogram and echocardiography —

Background The clinical significance of ST-segment depression (STD) on electrocardiogram (ECG) in resting patients without prior cardiac disease and symptoms of angina pectoris in unclear. This study was aimed to elucidate this problem. Methods Patients with non-anginal chest pain or those who underwent ECG screening were enrolled. Echocardiography (Echo) and resting and stress ECG were performed.; stress ECG was recorded during exercise and recovery period. For stress ECG, ST-segment/heart-rate loop was adopted. The clinical results in patients with and without STD on resting ECG were compared. Results Eighty-two patients were included; a mean age of 61.4 ± 14.1 years old. ECG revealed that 13 (15.9%) patients had left ventricular hypertrophy (LVH; Sokolow-Lyon’s voltage > 3.5 mV), whereas 34 (41.5%) patients had STD (ST-segment voltage at the J point < –0.05 mV). Echo revealed a mean left ventricular mass (LVM) of 182 ± 74 g. The stress ECG revealed the mean recovery index was –1.2° ± 19.1°. A correlation of STD voltage with Romhilt-Estes score on resting ECG (r = –0.34, p = 0.0015) and LVM on Echo (r = –0.26, p = 0.018) were observed. From ROC curves, STD tended to diagnose more accurately than other ECG parameters. From multiple logistic analysis, age, Romhilt-Estes score and peak STD on stress ECG were independently correlated with STD on resting ECG. Conclusion In the patients without prior cardiac disease and anginal chest pain, STD on resting ECG was suggestive of older age, LVH on ECG (independent) and LVH on Echo (not independent). Registration URL: https://www.umin.ac.jp/ctr/index.htm ; Unique identifier: UMIN000050291 WHAT IS KNOWN ST-segment depression (STD) on resting electrocardiogram (ECG) among the subjects without prior cardiac disease and symptoms of angina is suggested to imply left ventricular hypertrophy. WHAT THE STUDY ADDS In order to investigate the significance of STD on resting ECG among the subjects without history of cardiac disease or anginal chest pain, especially to rule out the incidence of silent myocardial ischemia, echocardiogram and stress ECG were contemporarily performed for them.