title: A new criterion combining ST/HR slope and deltaST/deltaHR index for detection of coronary artery disease in patients on digoxin therapy.
abstract: We evaluated the clinical value of a new index combining deltaST/delta heart rate (HR) index and ST/HR slope for diagnosing coronary artery disease (CAD) in patients on digoxin therapy. Exercise treadmill tests were performed by 72 patients on digoxin therapy. Simple HR-adjusted indexes of ST-segment depression during exercise (deltaST/deltaHR index) and the decline calculated from the final 12 data points relating ST-segment depression to HR (ST/HR slope) were determined. A new index was obtained by subtracting the deltaST/deltaHR index from the ST/HR slope. On thallium scintigraphy, 37 of the 72 patients showed reversible perfusion defects related to the diseased coronary artery. The new index derived from this ST-HR relation was 4.1 +/- 3.6 microV/beats/min in the ischemic group and 1.3 +/- 1.0 microV/beats/min in the group of patients without ischemia (p <0.0001). An ST-HR relation > or = 1.5 was found in 33 of the 37 patients in the ischemic group, and in 7 of the 35 patients without ischemia (p <0.0001). The sensitivity of this criterion for prediction of myocardial ischemia was 89%, the specificity was 80%, and the predictive accuracy was 85%. Thus, this new ST-HR index is useful for detecting CAD in patients on digoxin therapy.
authors.affiliation: First Department of Internal Medicine, Faculty of Medicine, Kagoshima University, Sakuragaoka, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Hamasaki
authors.forename: F
authors.initials: F
authors.lastname: Nakano
authors.forename: S
authors.initials: S
authors.lastname: Arima
authors.forename: M
authors.initials: M
authors.lastname: Tahara
authors.forename: M
authors.initials: M
authors.lastname: Kamekou
authors.forename: N
authors.initials: N
authors.lastname: Fukumoto
authors.forename: T
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: K
authors.initials: K
authors.lastname: Kihara
authors.forename: H
authors.initials: H
authors.lastname: Shono
authors.forename: S
authors.initials: S
authors.lastname: Nakao
authors.forename: H
authors.initials: H
authors.lastname: Tanaka
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000494:pharmacology* / Q000627:therapeutic use; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis* / Q000188:drug therapy; D004077:Digoxin / Q000494:pharmacology* / Q000627:therapeutic use; D004562:Electrocardiography / Q000187:drug effects*; D005080:Exercise Test; D005260:Female; D006329:Heart Conduction System / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity
chemical_list: D000889:Anti-Arrhythmia Agents; D004077:Digoxin