The exercise electrocardiogram: Differences in interpretation. Report of a technical group on exercise electrocardiography

Henry Blackburn; Gunnar Blomqvist; Alvin Freiman; Gottlieb C. Friesinger; Tom R. Hornsten; Larry Jackson; Charles S. LaMonte; Martin Lester; A. S. Most; Robert E. Mason; John Mazzarella; M. C. McNalley; Stuart Rosner; L. T. Sheffield; Ernst Simonson; Joseph Doyle; Samuel Fox; Richard Gubner; William L. Haskell; Herman K. Hellerstein; Pentti M. Rautaharju; T. Joseph Reeves

doi:10.1016/0002-9149(68)90305-6

The exercise electrocardiogram: Differences in interpretation. Report of a technical group on exercise electrocardiography

Henry Blackburn, Gunnar Blomqvist, Alvin Freiman, Gottlieb C. Friesinger, Tom R. Hornsten, Larry Jackson, Charles S. LaMonte, Martin Lester, A. S. Most, Robert E. Mason, John Mazzarella, M. C. McNalley, Stuart Rosner, L. T. Sheffield, Ernst Simonson, Joseph Doyle, Samuel Fox, Richard Gubner, William L. Haskell, Herman K. HellersteinPentti M. Rautaharju, T. Joseph Reeves

Epidemiology

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Abstract

Exercise electrocardiography is a valuable clinical tool with which quantitative evaluations and comparisons are now being attempted in many fields of cardiovascular investigation. Among a series of studies by a technical group on exercise electrocardiography, an assessment was made of observer variation in the clinical interpretation of ST-T responses during and after exercise. Interobserver variation among 14 cardiologists was great; individually assigned frequencies of abnormal responses after exercise in a mixed sample of records ranged from 5 to 58 per cent. Disagreement was greater for the diagnosis made during than for that made after exercise. Introbserver variation was also so great that use of the same observer for all exercise electrocardiographic readings would not necessarily provide acceptable reliability. The chief factors in disagreement were the lack of defined criteria for interpretation, in particular uncertainty about the significance of J-point ST-T depression, and technical quality of the records. Observer agreement was substantially increased when records were coded by unambiguous criteria or when simple measurements were made of the ST-T response after exercise.

Original language	English (US)
Pages (from-to)	871-880
Number of pages	10
Journal	The American Journal of Cardiology
Volume	21
Issue number	6
DOIs	https://doi.org/10.1016/0002-9149(68)90305-6
State	Published - Jun 1968

Bibliographical note

Funding Information:
A sample of 38 records of asymptomatic subjects was drawn from a large body of material on exercise in the files of the Cardiology Division, University of Washington School of Medicine. The data repre- * Meetings of this group are sponsored by the Heart Disease Control Program of the U. S. Public Health Service. The report was also made possible through a U. S. Public Health Service Grant on Physical Activity and Coronary Heart Disease to H. L. Taylor (CD-00118) and to the University of Minnesota Cardiovascular Center (HE-06314). .Iddress for reprints: Henry W. Blackburn, M.D., Laboratory of Physiological Hygiene, University of Minnesota School of Public Health, Stadium 27, Minneapolis, Minn. 55455.

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Blackburn, H., Blomqvist, G., Freiman, A., Friesinger, G. C., Hornsten, T. R., Jackson, L., LaMonte, C. S., Lester, M., Most, A. S., Mason, R. E., Mazzarella, J., McNalley, M. C., Rosner, S., Sheffield, L. T., Simonson, E., Doyle, J., Fox, S., Gubner, R., Haskell, W. L., ... Reeves, T. J. (1968). The exercise electrocardiogram: Differences in interpretation. Report of a technical group on exercise electrocardiography. The American Journal of Cardiology, 21(6), 871-880. https://doi.org/10.1016/0002-9149(68)90305-6

Blackburn, H, Blomqvist, G, Freiman, A, Friesinger, GC, Hornsten, TR, Jackson, L, LaMonte, CS, Lester, M, Most, AS, Mason, RE, Mazzarella, J, McNalley, MC, Rosner, S, Sheffield, LT, Simonson, E, Doyle, J, Fox, S, Gubner, R, Haskell, WL, Hellerstein, HK, Rautaharju, PM & Reeves, TJ 1968, 'The exercise electrocardiogram: Differences in interpretation. Report of a technical group on exercise electrocardiography', The American Journal of Cardiology, vol. 21, no. 6, pp. 871-880. https://doi.org/10.1016/0002-9149(68)90305-6

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abstract = "Exercise electrocardiography is a valuable clinical tool with which quantitative evaluations and comparisons are now being attempted in many fields of cardiovascular investigation. Among a series of studies by a technical group on exercise electrocardiography, an assessment was made of observer variation in the clinical interpretation of ST-T responses during and after exercise. Interobserver variation among 14 cardiologists was great; individually assigned frequencies of abnormal responses after exercise in a mixed sample of records ranged from 5 to 58 per cent. Disagreement was greater for the diagnosis made during than for that made after exercise. Introbserver variation was also so great that use of the same observer for all exercise electrocardiographic readings would not necessarily provide acceptable reliability. The chief factors in disagreement were the lack of defined criteria for interpretation, in particular uncertainty about the significance of J-point ST-T depression, and technical quality of the records. Observer agreement was substantially increased when records were coded by unambiguous criteria or when simple measurements were made of the ST-T response after exercise.",

author = "Henry Blackburn and Gunnar Blomqvist and Alvin Freiman and Friesinger, {Gottlieb C.} and Hornsten, {Tom R.} and Larry Jackson and LaMonte, {Charles S.} and Martin Lester and Most, {A. S.} and Mason, {Robert E.} and John Mazzarella and McNalley, {M. C.} and Stuart Rosner and Sheffield, {L. T.} and Ernst Simonson and Joseph Doyle and Samuel Fox and Richard Gubner and Haskell, {William L.} and Hellerstein, {Herman K.} and Rautaharju, {Pentti M.} and Reeves, {T. Joseph}",

note = "Funding Information: A sample of 38 records of asymptomatic subjects was drawn from a large body of material on exercise in the files of the Cardiology Division, University of Washington School of Medicine. The data repre- * Meetings of this group are sponsored by the Heart Disease Control Program of the U. S. Public Health Service. The report was also made possible through a U. S. Public Health Service Grant on Physical Activity and Coronary Heart Disease to H. L. Taylor (CD-00118) and to the University of Minnesota Cardiovascular Center (HE-06314). .Iddress for reprints: Henry W. Blackburn, M.D., Laboratory of Physiological Hygiene, University of Minnesota School of Public Health, Stadium 27, Minneapolis, Minn. 55455.",

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AU - Jackson, Larry

AU - LaMonte, Charles S.

AU - Lester, Martin

AU - Most, A. S.

AU - Mason, Robert E.

AU - Mazzarella, John

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N2 - Exercise electrocardiography is a valuable clinical tool with which quantitative evaluations and comparisons are now being attempted in many fields of cardiovascular investigation. Among a series of studies by a technical group on exercise electrocardiography, an assessment was made of observer variation in the clinical interpretation of ST-T responses during and after exercise. Interobserver variation among 14 cardiologists was great; individually assigned frequencies of abnormal responses after exercise in a mixed sample of records ranged from 5 to 58 per cent. Disagreement was greater for the diagnosis made during than for that made after exercise. Introbserver variation was also so great that use of the same observer for all exercise electrocardiographic readings would not necessarily provide acceptable reliability. The chief factors in disagreement were the lack of defined criteria for interpretation, in particular uncertainty about the significance of J-point ST-T depression, and technical quality of the records. Observer agreement was substantially increased when records were coded by unambiguous criteria or when simple measurements were made of the ST-T response after exercise.

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The exercise electrocardiogram: Differences in interpretation. Report of a technical group on exercise electrocardiography

Abstract

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