ISO/TS 22077-4:2019

TECHNICAL ISO/TS
SPECIFICATION 22077-4
First edition
2019-10
Health informatics — Medical
waveform format —
Part 4:
Stress test electrocardiography
Reference number
©
ISO 2019
© ISO 2019
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ii © ISO 2019 – All rights reserved

Contents Page
Foreword .iv
Introduction .v
1 Scope . 1
2 Normative references . 1
3 Terms, definitions, symbols and abbreviations . 1
3.1 Terms and definitions . 1
3.2 Symbols and abbreviated terms. 2
4 Outline of stress test cardiography rules . 2
4.1 Configuration of waveform data (see Figure 1) . 2
4.2 Time synchronization (see Figure 2) . 4
5 Waveform encoding . 5
5.1 General . 5
5.1.1 Full disclosure waveform (see Figure 3) . 5
5.1.2 Intermittent record waveform (see Figure 4) . 5
5.1.3 Abstract waveform (see Figure 5). 6
5.2 Waveform class . 7
5.2.1 General. 7
5.2.2 Waveform class for stress test electrocardiography . 8
5.2.3 Waveform class for full disclosure waveform . 8
5.2.4 Waveform class for intermittent recorded waveform . 8
5.2.5 Waveform type for abstract waveform . 8
5.3 Lead name (Waveform attributes) . 9
5.4 Sampling attributes .10
5.5 Frame attributes .10
5.6 Pointer .10
5.7 Filter information .11
6 Load information .11
6.1 General .11
6.2 Loading related events .11
6.3 Amount of load .13
7 Measurement information .14
7.1 General .14
7.2 Examination date/time .14
7.3 Rating of perceived exertion .15
7.4 R wave position .16
7.5 Interpretation and beat annotation .17
7.6 ST segment recognition points.17
7.7 ST segment measurement value .18
7.8 Other measurement value .18
Annex A (informative) Encoding of ST segment recognition point and measurement value .19
Annex B (informative) Encoding measurement value and interpretation .21
Annex C (informative) Example of waveform coding.23
Bibliography .30
Foreword
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This document was prepared by Technical Committee ISO/TC 215, Health informatics.
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iv © ISO 2019 – All rights reserved

Introduction
0.1  General
Stress test electrocardiography is an examination that is frequently used. It is used to check the changes
in biological phenomena such as electrocardiogram or blood pressure that occur during cardiac stress.
Cardiac stress can be seen via exercise or by intravenous pharmacological stimulation. The purpose of
this examination is to find cardiac abnormalities, such as myocardial ischemia disease or arrhythmia
during exertion, and to check the athletic capability of the cardiopulmonary function.
This document defines the detailed rules of stress test electrocardiogram waveform format that is
encoded according to the Medical waveform Format Encoding Rules (MFER). In addition to basic rules
defined in ISO 22077-1, there are rules for ECG waveforms electrocardiography (12lead ECG, etc.) and
long-term electrocardiography (Holter ECG) that are contained in other MFER technical specifications,
i.e. ISO/TS 22077-2 and ISO/TS 22077-3. Please refer to those specifications for additional information.
0.2  Information package added to the electrocardiogram
The stress test checks the changes in the electrocardiogram during exercise against the resting
electrocardiogram. To correctly interpret the changes, we also need to capture other waveforms such
as the blood pressure, respiration gas, SpO and the load information. These should be put into a single
package to be delivered to a third party such as a healthcare provider.
The purpose of this document is to describe waveforms of different nature in the package and how they
can be synchronized in order to be interpreted simultaneously by the recipient of the package.
0.3 About electrocardiography waveform encoding in MFER
It is recommended to store the original waveforms as much as possible, i.e. waveforms are not
irreversible compressed or filtered. This is to avoid losing the information contained in the original
waveform when reusing the waveform in research, etc. It is desirable to perform the processing
(e.g., Synthesized lead or filtering) needed for encoded waveforms. The configuration and condition
of an electrocardiogram recording may be encoded with waveform data to assure reproduction of
electrocardiographic representation when using a system such as electronic medical records. However,
it is entrusted to the system whether those can or cannot be reproduced using this information. There
are often large drift noises and EMGs on electrocardiograms during exercise stress tests. Some devices
perform special signal processing to remove these noises. And the system might not be able to perform
the same signal processing to reproduce the electrocardiogram that was recorded. In such a case, in
addition to the original waveform, storing the waveform after signal processing is also an option.
TECHNICAL SPECIFICATION ISO/TS 22077-4:2019(E)
Health informatics — Medical waveform format —
Part 4:
Stress test electrocardiography
1 Scope
This document defines the application of Medical waveform Format Encoding Rules (MFER) to
describe stress test electrocardiography, which is one of the outputs of exercise, pharmacological and
cardiopulmonary stress test. MFER performed in physiological laboratories, healthcare clinics, etc.
This document covers not only the electrocardiogram waveform but also the description of related
stress infor
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