Open AccessPredictive Value of Exercise Stress Test–Induced ST–Segment Changes in Leads V 1 and avR in Determining Angiographic Coronary Involvement
Author(s) -
Ghaffari Samad,
Asadzadeh Reza,
Tajlil Arezou,
Mohammadalian Amirhossein,
Pourafkari Leili
Publication year - 2017
Publication title -
annals of noninvasive electrocardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.494
H-Index - 48
eISSN - 1542-474X
pISSN - 1082-720X
DOI - 10.1111/anec.12370
Subject(s) - medicine , cardiology , st elevation , stenosis , artery , st depression , electrocardiography , lead (geology) , st segment , right coronary artery , coronary angiography , myocardial infarction , geomorphology , geology
Background The significance of electrocardiographic changes during exercise tolerance testing for distinguishing occluded artery is not well known. We tried to determine the role of ST elevation in leads aVR and V 1 during exercise in detecting stenosis of left main coronary artery and proximal left anterior descending artery. Methods ST segment changes during exercise in 230 patients, who underwent diagnostic angiography, were documented. The association of ST elevation in lead aVR , V 1 , leads aVR + V 1 , and STE in leads aVR + V 1 with ST depression in other leads with pattern of coronary stenosis were investigated. Results Left main and proximal left anterior artery stenosis were more common in patients with ST elevation in lead aVR (P < 0.001 for both). Similar association was found in the presence of ST elevation in lead V 1 . The presence of ST elevation ≥1 mm in lead aVR had a sensitivity of 100% and 94.3% for detecting left main and left anterior descending artery stenosis, respectively. The specificity was 33.5% and 26.6%, respectively. ST elevation in leads aVR + V 1 had a sensitivity of 74.4% and 65.9% and a specificity of 68.5% and 64.4% for detecting left main and left anterior descending arteries stenosis, respectively. Conclusion ST elevation in lead aVR is highly sensitive for left main and proximal left anterior descending artery lesions. Using ST elevation in lead V 1 in addition to lead aVR as a positive finding increases the specificity with a further decrease in sensitivity.