Key result
A decrease in the ST slope from 3- to 6-minutes postexercise correctly identified 88% of false-positive ST-segment depressions versus 19% of true-positives, with a total accuracy of 83%.
Why the study?
Does the recovery time-course of ST slope on exercise ECG improve discrimination of false-positive from true-positive ST-segment depressions in patients with a normal resting ECG?
Observational (n=198)
Does the recovery time-course of ST slope on exercise ECG improve discrimination of false-positive from true-positive ST-segment depressions in patients with a normal resting ECG?
The change in ST slope from 3 to 6 minutes post-exercise is a simple and reliable marker to differentiate false-positive from true-positive ST-segment depressions in patients with normal resting ECGs.
Answers are grounded in this paper and cite their sources.
ST slope recovery may aid differentiation of false-positive exercise ECG results; hypothesis-generating and requires prospective validation before clinical adoption.
BACKGROUND: Using the exercise ECG for diagnosing coronary artery disease (CAD) is hampered by the occurrence of false-positive (FP) ST-segment depression. Because it is known that the recovery ST-T time-course in CAD differs from that in FP subjects, the ST slope may help discriminate FP from true-positive (TP) results. METHODS AND RESULTS: Treadmill digitized ECG from patients with significant ST-segment depressions and normal resting ECG were analyzed in 134 patients with CAD on angiography (>50% narrowing) and reversible perfusion defects (TP group), and 64 subjects with normal perfusion (FP group) on exercise single photon emission computed tomography. The ST slope between the J-point and J(80) was measured every minute up to 6-min postexercise. The ST slope was significantly higher in FP than in TP at peak exercise, and at postexercise 1-, 2- and 3-min (p<0.01, all). Thereafter, it gradually increased in TP, while monotonically decreasing in FP. Its decrease from 3- to 6-min could correctly diagnose 88% of FP subjects, whereas it was found in only 19% of TP patients (total accuracy 83%). CONCLUSIONS: The ST slope change from early to late recovery is a simple yet reliable marker for discriminating FP from TP ST-segment responses in subjects with a normal resting ECG.
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Sakuragi et al. (2004) conducted an observational in Coronary artery disease (n=198). ST slope change from early to late recovery vs. True-positive vs False-positive ST-segment depressions was evaluated on Correct diagnosis of false-positive subjects based on ST slope decrease from 3- to 6-min postexercise (Total accuracy 83%). A decrease in the ST slope from 3- to 6-minutes postexercise correctly identified 88% of false-positive ST-segment depressions versus 19% of true-positives, with a total accuracy of 83%.
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