Heart rate adjustment of ST segment depression for improved detection of coronary artery disease

Circulation. 1989 Feb;79(2):245-55. doi: 10.1161/01.cir.79.2.245.


Normal values for heart rate-adjusted indexes of ST segment depression during treadmill exercise electrocardiography (the ST segment/heart rate slope and the delta ST segment/heart rate index) were derived from evaluation of 150 subjects with a low likelihood of coronary artery disease, including 100 normal subjects and 50 subjects with nonanginal chest pain. Partitions chosen by the method of percentile estimation to include 95% of normal subjects remained highly specific in subjects with nonanginal pain syndromes. Sensitivities of the derived partitions for detection of myocardial ischemia were tested in an additional 150 patients with a high likelihood of coronary disease, including 100 patients with angiographically demonstrated coronary obstruction and 50 patients with stable angina. In contrast to the 68% (102 of 150 subjects) sensitivity of standard exercise electrocardiographic criteria for the detection of disease in this population, the sensitivity of an ST segment/heart rate slope partition of 2.4 muV/beats/min was 95% (142 of 150 subjects, p less than 0.001), and the sensitivity of a delta ST segment/heart rate index partition of 1.6 muV/beats/min was 91% (137 of 150 subjects, p less than 0.001). Analysis of receiver-operating curves confirmed the superior performance of the heart rate-adjusted indexes throughout a wide range of test specificities. These findings suggest that heart rate adjustment of ST segment depression can markedly improve the clinical usefulness of the treadmill exercise electrocardiogram.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Angina Pectoris / physiopathology
  • Cardiac Catheterization
  • Coronary Disease / diagnosis*
  • Coronary Disease / pathology
  • Coronary Disease / physiopathology
  • Electrocardiography*
  • Exercise Test
  • Female
  • Heart Rate*
  • Humans
  • Male
  • Middle Aged
  • Reference Values
  • Sensitivity and Specificity