Kligfield-Okin index: revisiting the correction of ST depression for delta heart rate

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For a number of years the measurement of classic ST-segment depression during exercise stress testing has been the simplest and most widely used method for identifying the presence of myocardial ischemia. Methods to improve the detection rate of about 70% continue under the study. The test is definitely far from perfect. 1 Gianrossi R Detrano R Mulvihill D Lehmann K Dubach P Colombo A McArthur D Froelicher V Exercise-induced ST depression in the diagnosis of coronary artery disease a meta analysis. Circulation. 1989; 80: 87-98 Crossref PubMed Scopus (682) Google Scholar , 2 Okin P Kligfield P Heart rate adjustment of ST segment depression and performance of the exercise electrocardiogram a critical evaluation. J Am Coll Cardiol. 1995; 25: 1726-1735 Abstract Full Text PDF PubMed Scopus (76) Google Scholar Kligfield and Okin reported improved results by calculating the ST/heart rate (HR) slope and ΔST/ΔHR index. 3 Kligfield P Ameisen O Okin P Relation of the exercise ST/HR slope to simple heart rate adjustment of ST segment depression. J Electrocardiol. 1987; 20: 135-140 PubMed Google Scholar , 4 Kligfield P Ameisen O Okin P.M Heart rate adjustment of ST segment depression for improved detection of coronary artery disease. Circulation. 1989; 79: 245-255 Crossref PubMed Scopus (121) Google Scholar , 5 Kligfield P Okin P.M Heart rate adjustment of ST segment depression is the glass half empty or half full?. J Am Coll Cardiol. 1992; 19: 19-20 Abstract Full Text PDF PubMed Scopus (11) Google Scholar , 6 Detrano R Salcedo E Passalacqua M Friis R Exercise electrocardiographic variables. A critical appraisal. J Am Coll Cardiol. 1986; 8: 836-847 Abstract Full Text PDF PubMed Scopus (103) Google Scholar In this study, we decided to investigate the clinical usefulness of the index because its simplicity makes it a more practical manipulation in the exercise laboratory. The claims that the ΔST/ΔHR can improve the diagnostic accuracy of the stress test in detecting ischemia 3 Kligfield P Ameisen O Okin P Relation of the exercise ST/HR slope to simple heart rate adjustment of ST segment depression. J Electrocardiol. 1987; 20: 135-140 PubMed Google Scholar , 4 Kligfield P Ameisen O Okin P.M Heart rate adjustment of ST segment depression for improved detection of coronary artery disease. Circulation. 1989; 79: 245-255 Crossref PubMed Scopus (121) Google Scholar , 5 Kligfield P Okin P.M Heart rate adjustment of ST segment depression is the glass half empty or half full?. J Am Coll Cardiol. 1992; 19: 19-20 Abstract Full Text PDF PubMed Scopus (11) Google Scholar , 6 Detrano R Salcedo E Passalacqua M Friis R Exercise electrocardiographic variables. A critical appraisal. J Am Coll Cardiol. 1986; 8: 836-847 Abstract Full Text PDF PubMed Scopus (103) Google Scholar has been challenged by Detrano, 6 Detrano R Salcedo E Passalacqua M Friis R Exercise electrocardiographic variables. A critical appraisal. J Am Coll Cardiol. 1986; 8: 836-847 Abstract Full Text PDF PubMed Scopus (103) Google Scholar Lachtermann, 7 Lachtermann B Lehmann K Detrano R Neutel J Froelicher V Comparison of ST segment/heart rate index to standard ST criteria for analysis of exercise electrocardiogram. Circulation. 1990; 82: 44-50 Crossref PubMed Scopus (73) Google Scholar and others who reported that using a ΔST/ΔHR index does not improve accuracy over the standard test. 7 Lachtermann B Lehmann K Detrano R Neutel J Froelicher V Comparison of ST segment/heart rate index to standard ST criteria for analysis of exercise electrocardiogram. Circulation. 1990; 82: 44-50 Crossref PubMed Scopus (73) Google Scholar , 8 Quyyumi A.A Raphael M.J Wright C Bealing L Fox K.M Inability of the ST segment/heart rate slope to predict accurately the severity of coronary artery disease. Br Heart J. 1984; 51: 395-398 Crossref PubMed Scopus (36) Google Scholar , 9 Balcon R Brooks N Layton C Correlation of heart rate/ST slope and coronary angiographic findings. Br Heart J. 1984; 52: 304-307 Crossref PubMed Scopus (24) Google Scholar , 10 Ellestad M.H Crump R Surber M The significance of lead strength on ST change during treadmill stress test. J Electrocardiol. 1992; 25: 31-34 Abstract Full Text PDF PubMed Scopus (18) Google Scholar The purpose of this study was to analyze the index in our laboratory and determine if it improves the accuracy of the stress test in detecting ischemia.