title: Exercise electrocardiography detection of coronary artery disease by ST-segment depression/heart rate hysteresis in women: the Finnish Cardiovascular Study.
abstract: BACKGROUND
  The performance of exercise electrocardiography (ECG) for the detection of coronary artery disease (CAD) in women has been limited. The recently developed computerized variable, ST-segment depression/heart rate (ST/HR) hysteresis, has been proved to detect CAD in men more accurately than traditional methods. However, the diagnostic performance of ST/HR hysteresis has not been evaluated in women.
  
  
  METHODS
  The study population comprised 161 female patients from the Finnish Cardiovascular Study (FINCAVAS). All patients were referred for a routine bicycle exercise test. The maximum values of ST/HR hysteresis, ST/HR index, ST-segment depression at peak exercise (STpeak), at the end of one (ST1rec) and three (ST3rec) minutes of post-exercise were determined. Significant CAD was present in 48, while 65 women showed no angiographic CAD. Also a group of 48 women with low likelihood of CAD (LLC) was formed. Diagnostic performance of variables was assessed by receiver operating characteristic (ROC) analysis. Furthermore, sensitivity values at 80% specificity and specificities at 80% sensitivity were determined.
  
  
  RESULTS
  In a comparison between CAD and LLC groups, the ROC areas for ST/HR hysteresis, ST/HR index, STpeak, ST1rec and ST3rec were 0.89, 0.74, 0.65, 0.84 and 0.73, and sensitivities at 80% specificity were 88%, 67%, 52%, 75% and 60%, respectively. Comparing CAD and no-CAD groups, the ROC areas were 0.73, 0.67, 0.56, 0.63 and 0.60, and specificities at 80% sensitivity were 60%, 38%, 27%, 33% and 30%.
  
  
  CONCLUSIONS
  ST/HR hysteresis is a more competent method in CAD detection in women than ST-segment depression or ST/HR index.
authors.affiliation: Department of Biomedical Engineering, Tampere University of Technology, Finland.
authors.forename: Kati
authors.initials: K
authors.lastname: Svart
authors.forename: Rami
authors.initials: R
authors.lastname: Lehtinen
authors.forename: Tuomo
authors.initials: T
authors.lastname: Nieminen
authors.forename: Kjell
authors.initials: K
authors.lastname: Nikus
authors.forename: Terho
authors.initials: T
authors.lastname: Lehtimäki
authors.forename: Tiit
authors.initials: T
authors.lastname: Kööbi
authors.forename: Kari
authors.initials: K
authors.lastname: Niemelä
authors.forename: Mari
authors.initials: M
authors.lastname: Niemi
authors.forename: Väinö
authors.initials: V
authors.lastname: Turjanmaa
authors.forename: Mika
authors.initials: M
authors.lastname: Kähönen
authors.forename: Jari
authors.initials: J
authors.lastname: Viik
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology; D003936:Diagnosis, Computer-Assisted / Q000379:methods / Q000592:standards; D004562:Electrocardiography / Q000379:methods* / Q000592:standards*; D005080:Exercise Test / Q000379:methods* / Q000592:standards*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016387:Women's Health