Comparison of S-T segment/heart rate slope with exercise thallium imaging and conventional S-T segment criteria in detecting coronary artery disease: Effect of exercise level on accuracy
Journal
Cardiology
Journal Volume
89
Journal Issue
3
Pages
229-234
Date Issued
1998
Author(s)
Abstract
The S-T segment/heart rate (ST/HR) slope has been proposed as a more accurate electrocardiographic criterion for the diagnosis of coronary artery disease, but studies comparing the diagnostic value of the ST/HR slope with exercise thallium imaging are scant. The aims of this study were to assess the diagnostic accuracy of the ST/HR slope, conventional S-T segment criteria and exercise thallium imaging in detecting coronary artery disease and to evaluate the effect of exercise level on the sensitivity and specificity of these three techniques. Ninety consecutive patients underwent treadmill testing and exercise thallium single-photon emission computed tomography (SPECT) simultaneously. All 90 patients also underwent coronary angiography within 1 month of the exercise test. We found that exercise thallium SPECT had a significantly higher diagnostic accuracy than either the ST/HT slope or conventional S-T segment criteria (thallium imaging 82%, ST/HR slope 67%, conventional S-T segment criteria 63%). The overall accuracy of the ST/HR slope was slightly but insignificantly greater than conventional S-T segment criteria (ST/HR slope 67%, conventional S-T segment criteria 63%; p = 0.639). In 50 patients with a lower exercise level, defined as not achieving 85% of their maximal predicted heart rate, the accuracy of the ST/HR slope was insignificantly greater (ST/HR slope 72%, conventional S-T segment criteria 66%; p = 0.517). In 40 patients with adequate exercise, the accuracy rate was the same (60%) for both the ST/HR slope and conventional S-T segment criteria. We conclude that exercise thallium imaging is more accurate than the ST/HR slope in diagnosing coronary artery disease and that the accuracy of the ST/HR slope is marginally better than conventional S-T segment criteria only in patients with a lower exercise level, and not in those with adequate exercise.
SDGs
Other Subjects
thallium 201; adult; aged; angiocardiography; article; coronary artery disease; diagnostic accuracy; diagnostic value; exercise electrocardiography; exercise test; female; heart rate; human; intermethod comparison; intravenous drug administration; major clinical study; male; priority journal; single photon emission computer tomography; st segment; Coronary Disease; Diagnosis, Differential; Electrocardiography; Exercise Test; Female; Heart Catheterization; Heart Rate; Humans; Male; Middle Aged; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon
Type
journal article