Circulation, Vol 80, 87-98, Copyright © 1989 by American Heart Association
R Gianrossi, R Detrano, D Mulvihill, K Lehmann, P Dubach, A Colombo, D McArthur and V Froelicher
To evaluate the variability in the reported diagnostic accuracy of the
exercise electrocardiogram, we applied meta-analysis to 147 consecutively
published reports comparing exercise-induced ST depression with coronary
angiography. These reports involved 24,074 patients who underwent both
tests. Population characteristics and technical and methodologic factors,
including publication year, number of electrocardiographic leads, exercise
protocol, use of hyperventilation, definition of an abnormal ST response,
exclusion of certain subgroups, and blinding of test interpretation were
analyzed. Wide variability in sensitivity and specificity was found (mean
sensitivity, 68%; range, 23-100%; SD, 16%; and mean specificity, 77%;
range, 17-100%; SD, 17%). The four study characteristics found to be
significantly and independently related to sensitivity were the treatment
of equivocal test results, comparison with a "better" test such as thallium
scintigraphy, exclusion of patients on digitalis, and publication year. The
four variables found to be significantly and independently related to
specificity were the treatment of upsloping ST depressions, the exclusion
of subjects with prior infarction or left bundle branch block, and the use
of preexercise hyperventilation. Stepwise linear regression explained less
than 35% of the variance in sensitivities and specificities reported in the
147 publications. There is wide variability in the reported accuracy of the
exercise electrocardiogram. This variability is not explained by
information reported in the medical literature.
ARTICLES
Exercise-induced ST depression in the diagnosis of coronary artery disease. A meta-analysis
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