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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.

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