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International Journal of Bioelectromagnetism Vol. 5, No. 1, p. 91, 2003. |
www.ijbem.org |
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ROC Analysis of ST Amplitude and ST/HR
Difference in the Recovery Phase of the Exercise Electrocardiogram Test in
Detection Håkan Kronandera,
Werner Fischer-Colbrieb, Jacek Nowakc, aDepartment of Medical Engineering, Karolinska
Institutet, 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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