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Do the right precordial leads during exercise testing contribute to detection of coronary artery disease?
Kenji Ueshima1, Noboru Kobayashi, Junya Kamata
1Second Department of Internal Medicine, Iwate Medical University, Morioka, Japan. k_ueshima@imu.ncvc.go.jp
Insights
Additional right precordial leads (RPL) during exercise testing did not improve the detection of coronary artery disease (CAD). While RPL may help identify right coronary artery ischemia, it does not enhance overall exercise ECG diagnostic accuracy.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Exercise Physiology
Background:
- The diagnostic utility of additional right precordial leads (RPL) during exercise testing for detecting coronary artery disease (CAD) remains unclear.
- Standard 12-lead electrocardiogram (ECG) exercise testing is a common method for CAD diagnosis.
Purpose of the Study:
- To evaluate the effectiveness of RPL during exercise testing in diagnosing CAD.
- To determine if RPL improves the sensitivity and specificity of exercise ECG for CAD detection.
Main Methods:
- 157 patients suspected of CAD underwent treadmill exercise testing with standard 12 leads and 4 additional RPL (V3R, V4R, V5R, V6R).
- Conclusive exercise testing was defined by reaching at least 85% of predicted maximum heart rate or exhibiting positive ECG changes.
- Coronary angiography was performed to confirm the presence and severity of CAD.
Main Results:
- Of 157 patients, 67 had significant CAD. Standard 12-lead ECG showed 76% sensitivity and 86% specificity.
- Only three patients had positive changes in RPL, all with ST elevation and associated with coronary artery lesions.
- Combining RPL with the standard 12-lead method resulted in 78% sensitivity and 86% specificity, showing no significant improvement in diagnostic accuracy.
Conclusions:
- Additional right precordial leads (RPL) during exercise testing may offer insights into ischemia supplied by the right coronary artery.
- However, RPL do not enhance the overall diagnostic accuracy of the exercise electrocardiogram for detecting coronary artery disease.
Background:
It is still unknown whether or not the additional right precordial leads (RPL) during exercise testing contribute to detection of coronary artery disease (CAD).
Hypothesis:
The aim of this study was to evaluate the RPL during exercise testing for the detection of CAD.
Methods:
The study included 157 consecutive patients (116 men and 41 women, mean age 66 years) suspected of having CAD, who underwent conclusive treadmill exercise testing (heart rate reached at least 85% of the predicted maximum or positive electrocardiogram [ECG] changes were exhibited) and coronary angiography. During exercise testing, the ECG was recorded with the standard 12 leads and 4 RPL (V3R, V4R, V5R, V6R).
Results:
Of the 157 patients, 67 had CAD (> 75% stenosis in at least one major coronary artery), and 64 had positive ST changes in the standard ECG leads during exercise testing. Using the conventional 12-lead method, sensitivity and specificity were 76 and 86%, respectively. Only three patients exhibited positive changes in the RPL leads; all had > 0.1 mV ST elevation in one of the RPL leads with > 0.1 mV ST elevation in aVR. Two of these patients had significant right coronary artery lesions and the other had a lesion of the left anterior descending artery which perfused the inferior as well as the anteroseptal area. In the standard 12 leads, one of the patients with an abnormal RPL and a right coronary lesion was negative, while the other two patients were positive. Combining RPL with the conventional 12-lead method, sensitivity and specificity were 78 and 86%, respectively. Therefore, RPL did not improve the accuracy of the exercise ECG.
Conclusion:
The use of RPL during exercise testing may contribute to the detection of ischemia perfused by the right coronary artery; however, it does not improve the diagnostic accuracy of the exercise test.
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