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Predictive Value of Exercise Stress Test–Induced ST–Segment Changes in Leads V₁ and avR in Determining Angiographic Coronary Involvement

Corresponding Author

Samad Ghaffari M.D., F.A.C.C.

[email protected]

Cardiovascular Research Center, Tabriz University of Medicine, Tabriz, Iran

Address for correspondence: Samad Ghaffari, M.D., F.A.C.C., Professor of Cardiology, Cardiovascular Research Center, Tabriz University of Medicine, Tabriz 5166615573, Iran. Tel: +989143137973; Fax: +98-41-33363880; E-mail; [email protected]Search for more papers by this author

Reza Asadzadeh M.D.,

Reza Asadzadeh M.D.

Cardiovascular Research Center, Tabriz University of Medicine, Tabriz, Iran

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Arezou Tajlil M.D.,

Arezou Tajlil M.D.

Cardiovascular Research Center, Tabriz University of Medicine, Tabriz, Iran

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Amirhossein Mohammadalian M.D.,

Amirhossein Mohammadalian M.D.

Cardiology Department, Aalinasab Hospital, Tabriz, Iran

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Leili Pourafkari M.D., F.A.C.C.,

Leili Pourafkari M.D., F.A.C.C.

Cardiovascular Research Center, Tabriz University of Medicine, Tabriz, Iran

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Samad Ghaffari M.D., F.A.C.C.,

Corresponding Author

Samad Ghaffari M.D., F.A.C.C.

[email protected]

Cardiovascular Research Center, Tabriz University of Medicine, Tabriz, Iran

Reza Asadzadeh M.D.,

Reza Asadzadeh M.D.

Cardiovascular Research Center, Tabriz University of Medicine, Tabriz, Iran

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Arezou Tajlil M.D.,

Arezou Tajlil M.D.

Cardiovascular Research Center, Tabriz University of Medicine, Tabriz, Iran

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Amirhossein Mohammadalian M.D.,

Amirhossein Mohammadalian M.D.

Cardiology Department, Aalinasab Hospital, Tabriz, Iran

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Leili Pourafkari M.D., F.A.C.C.,

Leili Pourafkari M.D., F.A.C.C.

Cardiovascular Research Center, Tabriz University of Medicine, Tabriz, Iran

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First published: 25 May 2016

https://doi.org/10.1111/anec.12370

Citations: 10

Conflict of interest: The authors declare that they have no conflict of interest regarding this manuscript.

Funding: None.

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Abstract

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 V₁ 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, V₁, leads aVR + V₁, and STE in leads aVR + V₁ 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 V₁. 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 + V₁ 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 V₁ in addition to lead aVR as a positive finding increases the specificity with a further decrease in sensitivity.

References

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Volume22, Issue1

January 2017

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Predictive Value of Exercise Stress Test–Induced ST–Segment Changes in Leads V₁ and avR in Determining Angiographic Coronary Involvement

Abstract

Background

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References

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References

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Predictive Value of Exercise Stress Test–Induced ST–Segment Changes in Leads V1 and avR in Determining Angiographic Coronary Involvement

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Predictive Value of Exercise Stress Test–Induced ST–Segment Changes in Leads V₁ and avR in Determining Angiographic Coronary Involvement