Heart rate adjustment of the time-voltage ST segment integral: Identification of coronary disease and relation to standard and heart rate-adjusted ST segment depression criteria

AbstractTo assess the effect of heart rate adjustment of the magnitude of the ST integral (ST-HR integral) on exercise test performance, the exercise electrocardiogram (ECG) of 50 clinically normal subjects and 100 patients with known or suspected coronary artery disease was analyzed. At matched specificity of 96% with standard ECG criteria (≥0.1 mV of additional horizontal or downsloping ST segment depression), ar unadjusted ST integral partition of 16 μV-s identified coronary disease in the 100 patients with known or suspected disease with a sensitivity of only 41%, a value significantly lower than the 59% sensitivity of standard ECG criteria (p < 0.01) and the 65% sensitivity of an ST depression partition of 130 μV (p < 0.001).However, test performance of the ST integral was greatly improved by simple heart rate adjustment: at a matched specificity of 96%, an ST-HR integral partition of 0.154 μV-s/beat per min identified coronary disease in the 100 patients with a sensitivity of 90%, a value significantly greater than the 59% sensitivity of standard criteria and 65% sensitivity of ST depression criteria (each p < 0.001) and similar to the 91% sensitivity of the ST-HR index and 93% sensitivity of the ST-HR slope (each p = NS). Comparison of receiver-operating characteristic curves confirmed the superior overall test performance of the ST-HR integral relative to the ST integral and ST segment depression, and demonstrated improved performance that was comparable with that of the ST-HR index and the ST-HR slope.These findings support the value of heart rate adjustment of end-exercise repolarization changes during exercise electrocardiography and demonstrate that this approach significantly improves the performance of the ST integral in identifying coronary artery disease

Serial assessment of the electrocardiographic strain pattern for prediction of new‐onset heart failure during antihypertensive treatment: the LIFE study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106144/1/ejhfhfq224.pd

Electrocardiographic left atrial abnormality and stroke subtype in the atherosclerosis risk in communities study: Left Atrial Abnormality and Stroke Subtype

To assess the relationship between abnormally increased P-wave terminal force in lead V1 (PTFV1), an electrocardiographic (ECG) marker of left atrial abnormality, and incident ischemic stroke subtypes. We hypothesized that associations would be stronger with non-lacunar stroke, since we expected left atrial abnormality to reflect the risk of thromboembolism rather than in-situ cerebral small-vessel occlusion