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Correlation of coronary artery stenosis site with anterior or inferior projection of ST changes induced by treadmill
T Tanabe1, K Yoshioka, K Takahasi
1Department of Cardiology, Tokai University School of Medicine, Isehara, Japan.
Insights
A 9-lead DCG Holter monitor effectively detects coronary artery disease during treadmill tests. Specific leads like CM5, CM3, HL, and LB are crucial for identifying ST depressions and elevations, aiding diagnosis.
Area of Science:
- Cardiology
- Medical Devices
- Diagnostic Imaging
Background:
- Coronary artery disease (CAD) diagnosis often relies on electrocardiography (ECG).
- Evaluating ECG lead configurations for improved detection during exercise stress testing is essential.
Purpose of the Study:
- To assess the diagnostic performance of a 9-lead DCG Holter monitor compared to a 12-lead ECG.
- To correlate ST-segment changes during treadmill testing with coronary stenosis.
- To evaluate ST-elevation detection in acute myocardial infarction (AMI) using the 9-lead DCG.
Main Methods:
- Simultaneous recording using a 9-lead DCG and a 12-lead ECG during treadmill exercise testing (Td-test) in 140 CAD patients.
- Coronary arteriography in 118 patients to correlate stenosis with ST depressions.
- Analysis of ST elevation detection in 10 AMI patients.
Main Results:
- The CM5 lead showed ST depressions in 92% of patients with detectable changes.
- High lateral (HL) and low lateral leads captured all ST depressions seen in leads I and aVL.
- Specific leads demonstrated varying sensitivity and specificity for different coronary artery territories; the LB lead showed high sensitivity (88%) and specificity (86%) for RCA disease.
Conclusions:
- A 9-lead DCG Holter monitor is effective for diagnosing CAD during Td-test.
- The combination of CM5, CM3, HL, and LB leads provides comprehensive detection of ischemic events.
- The LB lead is particularly valuable for identifying inferior ischemia and RCA disease.
Abstract:
A 9-lead Holter monitor using the lead-switching technique (9-lead DCG) and conventional 12-lead electrocardiograph (12-lead ECG) were simultaneously used for recording during treadmill exercise testing (Td-test) in 140 patients with coronary artery disease. Coronary arteriography was performed in 118 of the 140 patients, and the correlation between coronary stenosis and anterior or inferior projection of ST depressions occurring during the Td-test was investigated. Additionally, 10 patients with acute myocardial infarction (AMI) were studied to test ST elevation detection by the 9-lead DCG. The CM5 lead demonstrated ST depressions in 92 of the 109 patients showing ST depressions in one or more leads. High lateral (HL) and/or low lateral leads detected all ST depressions occurring in the I and aVL leads of the 12-lead ECG. Leads CM1, CM2 and CM3 exhibited low sensitivity (0-32%) and high specificity (56-100%), while leads CM4, CM5, and CM6 provided greater sensitivity (66-95%), but less specificity (3-32%) in detecting diseases of the left anterior descending artery, left circumflex artery and/or right coronary artery (RCA). In contrast, the low back (LB) lead demonstrated high sensitivity (88%) and high specificity (86%) in detecting RCA disease. Lead CM3 detected ST elevations in all 6 patients with anterior AMI, while the LB lead did so in all 4 patients with inferior AMI. With a Holter monitor, 4 leads are needed: CM5 like, CM3 like, lateral (such as HL) and inferior (such as LB). The LB lead is useful in detecting inferior ischemia.