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International Journal of Bioelectromagnetism
Vol. 5, No. 1, p. 91, 2003.

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ROC Analysis of ST Amplitude and ST/HR Difference in the Recovery Phase of the Exercise Electrocardiogram Test in Detection
of Myocardial Ischemia

Håkan Kronandera, Werner Fischer-Colbrieb, Jacek Nowakc,
Lars-Åke Brodinc, Håkan Elmqvista

aDepartment of Medical Engineering, Karolinska Institutet, Huddinge, Sweden
bDepartment of Clinical Physiology, Mälar Hospital, Eskilstuna, Sweden
cDepartment of Clinical Physiology, Huddinge University Hospital, Huddinge, Sweden


Abstract. The exercise electrocardiographic (ECG) test plays an important role in evaluating myocardial ischemia and detecting patients with coronary artery disease (CAD). Studies have shown that analysis of ST segment amplitude/heart rate (ST/HR) curve, involving the recovery phase, can improve the accuracy of exercise ECG test. This presentation describes the diagnostic value of ST amplitude and ST/HR curve in different leads and different time points during the post-exercise recovery phase in a clinical population of 2,062 patients selected from 8,322 patients referred to the department of Clinical Physiology at Mälar Hospital, Sweden, for a routine bicycle exercise ECG test. Of these 2,062 selected patients, 668 had angiographically proven CAD, 119 had no CAD according to angiography, 242 had no reversible or permanent defect according to myocardial scintigraphy and 1,033 were clinically normal with respect to cardiac disease. The area under the receiver operating characteristic (ROC) curve for the ST amplitude was calculated for each of the standard 12 leads in the exercise ECG in time increments of 12 seconds from 4 minutes before to 10 minutes after the end of the exercise phase. A method for calculating the ST/HR difference from the ST/HR curve is described and the area under the ROC curve for the ST/HR difference was calculated in the same way as for ST amplitude, but only for the post-exercise recovery phase. Males and females are handled separately. A novel color map is introduced to visualize ROC areas in different leads during time. Such maps show that the highest diagnostic values for these parameters will be found during the first 2 minutes after end of the exercise phase with the peak around 1 minute after exercise.

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