Showing papers by "Jaap W. Deckers published in 1989"
TL;DR: Discriminant analysis and ST segment amplitude changes adjusted for heart rate had excellent diagnostic characteristics, which were little affected by concomitant use of beta blockers and seem well suited for diagnostic application in clinical practice.
Abstract: The diagnostic accuracy of the following methods of analysing exercise tests were evaluated: (a) the cumulative area of ST segment depression during exercise normalised for workload and heart rate (exercise score); (b) discriminant analysis of electrocardiographic exercise variables, workload, and symptoms; and (c) ST segment amplitude changes during exercise adjusted for heart rate. Three hundred and forty five men without a history of myocardial infarction were studied. One hundred and twenty three were apparently healthy. Less than half (170) had coronary artery disease. All had a normal electrocardiogram at rest. A Frank lead electrocardiogram was computer processed during symptom limited bicycle ergometry. The accuracy of the exercise score (a) was low (sensitivity 67%, specificity 90%). Discriminant analysis (b) and ST segment amplitude changes adjusted for heart rate (c) had excellent diagnostic characteristics (sensitivity 80%, specificity 90%), which were little affected by concomitant use of beta blockers. Both methods seem well suited for diagnostic application in clinical practice.
53 citations
TL;DR: The diagnostic yield of exercise testing in females can be improved by use of more sophisticated electrocardiographic and exercise variables, and leads with inferiorly directed vectors should be used for diagnostic purposes in females.
Abstract: The diagnostic accuracy of conventional exercise electrocardiography was compared with exercise algorithms specifically aimed at application in females, with R wave and heart rate adjusted ST-segment changes, and with discriminant analysis. A symptom-limited bicycle exercise test was performed by 189 females without previous infarction with a normal electrocardiogram (ECG) at rest. Frank lead ECG was computer processed. ST-segment amplitudes in lead X were superior to measurements in lead Y, but their sensitivity amounted only to 50% at a specificity of 90%. Correction for R wave amplitude marginally increased sensitivity. It was confirmed that leads with inferiorly directed vectors such as standard leads II, III, aVF or Frank lead Y should not be used for diagnostic purposes in females. Exercise-induced increases in R-wave amplitude of at least 0.1 mV occurred in only 8% of females with coronary disease. Previously described discriminant function using attained heart rate, ST-segment depression and a sex-dependent ST segment correction factor yielded a sensitivity of 60% at a specificity of 90%. Sensitivities of heart rate adjusted ST-segment changes and of a previously proposed discriminant function were greater than 70% at a specificity of 90%. It is concluded that the diagnostic yield of exercise testing in females can be improved by use of more sophisticated electrocardiographic and exercise variables.
12 citations
01 Jan 1989
TL;DR: Both methods forfanalysing exercise test seem wellsuited for diagnostic application inclinical practice.
Abstract: SUMMARY Thediagnostic accuracyofthefollowing methodsofanalysing exercise testswere evaluated: (a)thecumulative areaofST segmentdepression duringexercise normalised for workload andheart rate(exercise score); (b)discriminant analysis ofelectrocardiographic exercise variables, workload, andsymptoms; and(c)ST segment amplitude changes duringexercise adjusted forheart rate.Threehundredandforty five men without a history ofmyocardial infarction were studied. Onehundredandtwentythree were apparently healthy. Lessthanhalf (170)hadcoronary arterydisease. Allhada normalelectrocardiogram atrest.A Franklead electrocardiogram was computerprocessed during symptom limited bicycle ergometry.The accuracy oftheexercise score (a)was low(sensitivity 67%,specificity 90%).Discriminant analysis (b)andSTsegmentamplitude changes adjusted forheart rate(c)hadexcellent diagnostic characteristics (sensitivity 80%,specificity 90%)°, which were little affected byconcomitant useof ,Bblockers. Bothmethods seem wellsuited fordiagnostic application inclinical practice.