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June 15, 1998Annals of Internal Medicine

The Electrocardiographic Exercise Test in a Population with Reduced Workup Bias: Diagnostic Performance, Computerized Interpretation, and Multivariable Prediction

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Why the study?

Do computerized ST-segment measurements and multivariable equations improve the diagnostic utility of the exercise test compared to visual ST-segment measurements in patients with angina pectoris?

Population

814 consecutive patients presenting with angina pectoris who agreed to undergo both exercise testing and…

Comparison

Computerized ST-segment measurements and… vs Visual ST-segment measurements made by…

Design

Cohort

Authors

VFVictor F. FroelicherKLKenneth G. LehmannRTR. L. Thomas

Discussion

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Overview

Multivariable equations may enhance exercise test discrimination in angina; leaves open prospective validation and outcome impact before practice change.

Key Points

  • To evaluate the diagnostic accuracy of computerized ST-segment measurements, empirical scores, and multivariable equations compared with visual ST-segment analysis in a patient cohort with reduced workup bias.
  • Prospective multicenter study conducted across 12 university-affiliated Veterans Affairs Medical Centers in N=814 consecutive patients presenting with angina pectoris.
  • All patients underwent digital exercise electrocardiography and coronary angiography, with data evaluated by core laboratories.
  • Visual ST-segment analysis demonstrated a sensitivity of 45% and a specificity of 85% in a study cohort with 50% disease prevalence.
  • Computerized ST-segment measurements performed similarly to visual interpretations by cardiologists.
  • Multivariable equations integrating non-electrocardiographic variables significantly improved discrimination over visual ST analysis (area under the ROC curve: 0.80 vs. 0.68; P < 0.001), correctly reclassifying 5 additional patients per 100 tested.

Structured PICO

Do computerized ST-segment measurements and multivariable equations improve the diagnostic utility of the exercise test compared to visual ST-segment measurements in patients with angina pectoris?

P
Population
814 consecutive patients presenting with angina pectoris who agreed to undergo both exercise testing and coronary angiography at 12 university-affiliated Veterans Affairs Medical Centers.
I
Intervention
Computerized ST-segment measurements and multivariable equations incorporating nonelectrocardiographic variables
C
Comparator
Visual ST-segment measurements made by cardiologists
O
Outcome
Diagnostic utility (sensitivity, specificity, and area under the receiver-operating characteristic curve)surrogate

Multivariable equations incorporating clinical variables and ST-segment measurements significantly improve the diagnostic accuracy of exercise testing compared to visual ST-segment analysis alone.

Cite This Study

Froelicher et al. (1998) studied this question.

synapsesocial.com/papers/6a7e7b0b7cc91b73254d93b4https://doi.org/10.7326/0003-4819-128-12_part_1-199806150-00001
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Diagnostic value of computerized exercise testing in men without previous myocardial infarction. A multivariate, compartmental and probabilistic approach1985 · 61 citations
  2. 2On-line Analysis of the Exercise Electrocardiogram1969 · 100 citations
  3. 3The Diagnostic Performance of Computer Programs for the Interpretation of Electrocardiograms1991 · 544 citations
  4. 4Clinical value of quantitative analysis of ST slope during exercise.1977 · 40 citations
  5. 5A lesson from the controversy about heart rate adjustment of ST segment depression.1991 · 22 citations