title: Visual versus computerized analysis of upsloping ST segment depression in the exercise electrocardiogram.
abstract: A slowly upsloping ST segment depression is an abnormal, and a rapidly upsloping ST segment depression is a normal exercise ECG response. We investigated the agreement of expert physicians on the visual classification of the ST segment depression, and compared the (majority) vote with the computer-generated ST slope. A total of 206 exercise ECG leads with an amplitude of the ST segment depression > or = 0.15 mV and a ST segment slope > or = 0.5 mVs(-1) were evaluated. All three interpreters agreed in 68 cases, two agreed in 123 cases, and all disagreed in 15 cases. Intraobserver agreement was 61%. The ST segment slope was significantly (p < 0.001) greater in leads generally interpreted as rapidly upsloping (n = 38; 2.1 +/- 0.8 mVs(-1)), than in those interpreted as slowly upsloping (n 121; 1.3 +/- 0.6 mVs(-1)) or horizontal (n = 32; 1.1 +/- 0.4 mVs(-1)), although there was some overlap. Thus, standardization of the computer-assisted exercise ECG interpretation should be continued.
authors.affiliation: Department of Clinical Physiology, North Karelia Central Hospital, Joensuu, Finland. markku.walamies@pkshp.fi
authors.forename: M A
authors.initials: MA
authors.lastname: Walamies
authors.forename: T
authors.initials: T
authors.lastname: Kööbi
authors.forename: L I
authors.initials: LI
authors.lastname: Hämäläinen
authors.forename: E A
authors.initials: EA
authors.lastname: Ahonen
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002637:Chest Pain / Q000175:diagnosis; D003327:Coronary Disease / Q000175:diagnosis*; D003936:Diagnosis, Computer-Assisted; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011336:Probability; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted; D014796:Visual Perception