The Diagnostic Value of Heart Rate During Exercise Electrocardiography
Joy M. Kaplan MD
Paul Kligfield MD
Peter M. Okin MD

$7.95 		Journal of Cardiopulmonary Rehabilitation & Prevention
June 2005 
Volume 25  Number 3
Pages 127 - 134
 
  PDF Version Available!

ABSTRACT
Outline

  • CHRONOTROPIC RESPONSE TO EXERCISE

  • HEART RATE ADJUSTMENT OF ST-SEGMENT DEPRESSION

  • The Regression-based ST/HR Slope

  • The Simple ST/HR Index

  • HEART RATE RECOVERY

  • HEART RATE ADJUSTMENT IN THE POST-EXERCISE RECOVERY PERIOD

  • The Simple Rate-recovery Loop

  • Quantitative Rate-recovery Loops

  • IMPLICATIONS AND DIRECTIONS

  • References



    • Graphics

  • Figure 1

  • Figure 2

    • Exercise testing remains the most widely used method for detecting the presence of coronary artery disease and for assessing its severity. 1–3 Clinical usefulness of the exercise electrocardiogram (ECG), however, has been limited by poor sensitivity and poor predictive value of standard ST-segment depression criteria for the identification of patients with coronary obstruction. 1,2,4,5 Recognition of these limitations has led to the development of novel approaches to exercise ECG interpretation, many of which are based on incorporation of heart rate data acquired during exercise and recovery. 3,6

    Heart rate is an integral component of the exercise ECG that is easily and accurately measurable. Alone and in combination with ST-segment changes, heart rate can provide insight into cardiac performance and the supply-demand balance of the ischemic heart. 7–9 Simple evaluation of heart rate dynamics alone can have diagnostic and predictive value, as found for chronotropic incompetence during exercise and heart rate recovery after exercise. 10–14 Heart rate is linearly related to the changing myocardial oxygen demand that accompanies progressive exercise. 15 Adjustment of ST-segment depression for corresponding changes in myocardial oxygen demand that are related to heart rate is therefore physiologically logical. 16,17 The resolution of ST-segment changes in ...

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