Evaluation of Electrocardiographic Leads Using Conventional ST-Segment Depression and ST-Segment Depression/Heart Rate Hysteresis for Diagnosing of Coronary Artery Disease in Women Population: The Finnish Cardiovascular Study

Studies have shown that ST-segment depression/heart rate (ST/HR) hysteresis improves the limited diagnosing accuracy of exercise electrocardiography in detection of coronary artery disease in women. To the best of our knowledge, the methods developed the lack comprehensive comparison of a lead-by-lead basis and have been validated with limited number of female populations. The study aimed to evaluate the effect of 12 electrocardiographic leads on the diagnostic performance of ST/HR hysteresis and the traditional ST-segment depression at maximum exercise. This study analyzed 239 women participating in the Finnish Cardiovascular Study. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the overall diagnostic performance. The areas under the ROC curve for ST/HR hysteresis in all leads were more than 80%, while leads V1 and aVL achieved the smallest area, 73% and 33% respectively. Almost all leads for the conventional ST-segment depression at the peak exercise achieved below 70% areas under the ROC curve. At 80% of specificity, the sensitivity values obtained for the variable ST/HR hysteresis were promising in all leads except in leads V1 and aVL. This study suggests that except leads V1 and aVL, all leads can be applied when ST/HR hysteresis is used for the diagnosing of coronary artery disease in women. The diagnostic performance of conventional ST-segment depression at peak exercise was limited for the diagnosing of coronary artery disease in women.