Okin P M, Kligfield P
Department of Medicine, New York Hospital-Cornell Medical Center, New York 10021, USA.
J Am Coll Cardiol. 1995 Jun;25(7):1726-35. doi: 10.1016/0735-1097(95)00085-i.
Analysis of the rate-related change in exercise-induced ST segment depression using the exercise ST segment/heart rate slope and ST segment/heart rate index can improve the accuracy of the exercise electrocardiogram (ECG) for the identification of patients with coronary artery disease, recognition of patients with anatomically or functionally severe coronary obstruction and detection of patients at increased risk for future coronary events. These methods provide a more physiologic approach to analysis of the ST segment response to exercise by adjusting the apparent severity of ischemia for the corresponding increase in myocardial oxygen demand, which in turn can be linearly related to increasing heart rate. Solid-angle theory provides a model for the linear relation of ST segment depression to heart rate during exercise and a framework for understanding the relation of the ST segment/heart rate slope to the presence and extent of coronary artery disease. False positive and false negative test results of the heart rate-adjusted methods are well known in selected populations and require further clarification. Application of these methods is also highly dependent on the type of exercise protocol, number of ECG leads examined, timing of ST segment measurement relative to the J point and accuracy and precision of ST segment measurement. These methodologic details have been an important limitation to test application when traditional protocols and measurement procedures are required. When applied with attention to required details, the heart rate-adjusted methods can improve the usefulness of the exercise ECG in a range of clinically relevant populations.
使用运动ST段/心率斜率和ST段/心率指数分析运动诱发的ST段压低的速率相关变化，可提高运动心电图（ECG）识别冠心病患者、识别解剖学或功能上严重冠状动脉阻塞患者以及检测未来发生冠状动脉事件风险增加患者的准确性。这些方法通过根据心肌需氧量的相应增加调整缺血的表观严重程度，为分析运动时ST段反应提供了一种更符合生理的方法，而心肌需氧量又与心率增加呈线性相关。立体角理论为运动期间ST段压低与心率的线性关系提供了一个模型，并为理解ST段/心率斜率与冠状动脉疾病的存在及程度之间的关系提供了一个框架。心率校正方法的假阳性和假阴性检测结果在特定人群中是众所周知的，需要进一步阐明。这些方法的应用还高度依赖于运动方案的类型、检查的心电图导联数量、相对于J点的ST段测量时间以及ST段测量的准确性和精确性。当需要传统方案和测量程序时，这些方法学细节一直是测试应用的一个重要限制。如果在应用时注意所需细节，心率校正方法可以提高运动心电图在一系列临床相关人群中的实用性。
