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Improvement in diagnostic accuracy of exercise test with st/hr hysteresis in detection of significant coronary artery disease

Abstract

Introduction: The epidemiological shift increases the burden that come from non-communicable disease such as coronary heart disease (CHD). Our current gold standard for diagnosing CHD remains the invasive angiography procedure. Alternative diagnostics such as cardiac exercise test with ST change standard have limited diagnostic capacity. A newly studied alternative is the ST/HR hysteresis. This study aim to compare diagnostic capacity of cardiac exercise tests using different standards: ST change and ST/HR hysteresis.

Methods: This study employed case-control diagnostic study design. Samples were recruited consecutively from patients registered in cardiology polyclinic in Sanglah General Hospital during period of study. Exclusion criteria include asymptomatic stent placement, post-coronary bypass, and patients with incomplete data. Data were obtained from medical records and analyses performed included descriptive analyses, ROC analyses, and sensitivity-specificity analyses using IBM SPSS 25.0 software.

Results: Samples totaled 134 subjects, 106 of whom were male (79,1%) and 27 (20,9%) female. Mean age was 55,4 + 8,8 years old. Of 134 subjects, 59 were confirmed to have CHD based on angiography results meanwhile 75 subjects were not found to have significant coronary arterial lesion. ROC analyses put cut off point for ST/HR hysteresis at 0,026 mV and based on this cut off point 58 were grouped as CHD-suspect (> 0,026 mV) and 76 were not. Sensitivity and specificity was 79,7% and 85,3% respectively. Based on diagnostics cross-tabulation we calculate net reclassification improvement which stood at 0,28.

Conclusion: Cardiac exercise test using ST/HR hysteresis as diagnostic standard with cut-off point of 0,026 mV was found to be an improvement on diagnostic capacity compared to standard ST change standard. More studies need to be performed to account for the different results found in different population.

 

Pendahuluan: Pergeseran epidemiologis meningkatkan beban yang berasal dari penyakit tidak menular seperti penyakit jantung koroner (PJK). Standar emas saat ini untuk mendiagnosis PJK tetap merupakan prosedur angiografi invasif. Diagnosis alternatif seperti uji latih jantung dengan standar perubahan segmen ST memiliki kapasitas diagnostik terbatas. Parameter alternatif adalah histeresis ST/HR. Penelitian ini bertujuan untuk membandingkan kapasitas diagnostik uji latih jantung menggunakan standar yang berbeda: perubahan ST dan histeresis ST / HR.

Metode: Penelitian ini menggunakan desain studi diagnostik kasus- kontrol. Sampel direkrut secara berurutan dari pasien yang terdaftar di poliklinik kardiologi di Rumah Sakit Umum Sanglah selama masa studi. Kriteria eksklusi meliputi pasien post-stent yang asimptomatik, pasca operasi pintas koroner, dan pasien dengan data yang tidak lengkap. Data diperoleh dari rekam medis dan analisis yang dilakukan termasuk analisis deskriptif, analisis kurva ROC, dan analisis spesifisitas sensitivitas menggunakan perangkat lunak IBM SPSS 25.0.

Hasil: Sampel berjumlah 134 subjek, 106 di antaranya adalah laki-laki (79,1%) dan 27 (20,9%) perempuan. Usia rata-rata adalah 55,4 + 8,8 tahun. Dari 134 subjek, 59 dikonfirmasi memiliki PJK berdasarkan hasil angiografi, sementara 75 subjek tidak ditemukan memiliki lesi arteri koroner yang signifikan. Analisis ROC menempatkan titik cut-off untuk histeresis ST / HR pada 0,026 mV dan berdasarkan pada titik cut-off ini 58 dikelompokkan sebagai PJK (> 0,026 mV) dan 76 tidak. Sensitivitas dan spesifisitas masing- masing adalah 79,7% dan 85,3%. Berdasarkan tabulasi silang diagnostik kami mendapatkan peningkatan reklasifikasi bersih yang berada di 0,28.

Kesimpulan: Uji latih jantung dengan menggunakan histeresis ST / HR sebagai standar diagnostik dengan cut-off point 0,026 mV ditemukan peningkatan kapasitas diagnostik dibandingkan dengan standar perubahan segmen ST. Penelitian lebih lanjut perlu dilakukan untuk menjelaskan hasil yang berbeda yang ditemukan pada populasi yang berbeda

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How to Cite

Suryaguna, S., Wiryawan, I. N., & Wita, I. W. (2020). Improvement in diagnostic accuracy of exercise test with st/hr hysteresis in detection of significant coronary artery disease. Medicina, 51(1). https://doi.org/10.15562/medicina.v51i1.857

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