Open AccessExercise test predictors of severe coronary artery disease: Role of ST ‐segment elevation in lead aVR
Author(s) -
Russo Giulio,
Ravenna Salvatore Emanuele,
De Vita Antonio,
Aurigemma Cristina,
Lamendola Priscilla,
Lanza Gaetano Antonio,
Crea Filippo
Publication year - 2017
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22637
Subject(s) - medicine , coronary artery disease , cardiology , odds ratio , st segment , confidence interval , stenosis , st depression , myocardial infarction
Background The role of exercise stress test ( EST )‐induced ST ‐segment elevation ( STE ) in electrocardiographic lead aVR in predicting severe coronary artery disease ( CAD ) is controversial. Hypothesis Assessment of lead aVR during EST can be helpful to identify patients with severe CAD . Methods We performed maximal EST in 200 patients undergoing coronary angiography for suspect of CAD . Four angiographic findings of severe CAD were considered: (1) left main ( LM ) disease; (2) LM or equivalent LM ( LM / EQLM ) disease; (3) LM or proximal left anterior descending ( LAD ) artery ( LM / proxLAD ) disease; and (4) LM or 3‐vessel ( LM / 3V ) disease. Results LM , LM / EQLM , LM / proxLAD , and LM / 3V disease were shown in 6 (3%), 13 (6.5%), 33 (16.5%), and 27 (13.5%) patients, respectively. EST ‐induced STE in aVR occurred in 41 patients (20.5%). ST ‐segment depression ( STD ) in ≥5 leads was the only predictor of LM stenosis (odds ratio [ OR ]: 6.18, 95% confidence interval [ CI ]: 1.19‐32.2, P = 0.03) and the most significant variable associated with LM / proxLAD stenosis ( OR : 4.73, 95% CI : 2.0‐11.2, P = 0.0001); maximal STD ≥3 mm was the most significant variable associated with LM / EQLM ( OR : 7.58, 95% CI : 2.31‐24.9, P = 0.001) and LM / 3V ( OR : 3.86, 95% CI : 1.47‐10.1, P = 0.006) CAD . EST ‐induced STE in aVR was associated with LM / proxLAD disease only ( OR : 3.23, 95% CI : 1.44‐7.24, P = 0.004). At multivariate analysis, STD in ≥5 leads was the only independent predictor of LM / proxLAD disease ( OR : 3.99, 95% CI : 1.58‐10.1, P = 0.003). Conclusions EST ‐induced STE in lead aVR does not significantly increase the prediction of severe CAD compared with severity and extension of STD as assessed in the other electrocardiographic leads.