Visual versus computerized analysis of upsloping ST segment depression in the exercise electrocardiogram

A slowly upsloping ST segment depression is an abnormal, and a rapidly upsl oping ST segment depression is a normal exercise ECG response. We investiga ted the agreement of expert physicians on the visual classification of the ST segment depression, and compared the (majority) vote with the computer-g enerated ST slope. A total of 206 exercise ECG leads with an amplitude of t he ST segment depression greater than or equal to 0.15 mV and a ST segment slope greater than or equal to 0.5 mVs(-1) were evaluated. All three interp reters agreed in 68 cases, two agreed in 123 cases, and all disagreed in 15 cases. Intraobserver agreement was 61%. The ST segment slope was significa ntly (p < 0.001) greater in leads generally interpreted as rapidly upslopin g (n = 38; 2.1 +/- 0.8 mVs(-1)), than in those interpreted as slowly upslop ing (n 121; 1.3 +/- 0.6 mVs(-1)) or horizontal (n = 32; 1.1 +/- 0.4 mVs(-1) ), although there was some overlap. Thus, standardization of the computer-a ssisted exercise ECG interpretation should be continued. Copyright (C) 2000 S. Karger AG, Basel.