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Right-sided chest leads in exercise testing for detection of coronary restenosis.
Andreas P Michaelides1, Charalampos I Liakos, Charalambos Antoniades
1Exercise Laboratory, 1st University Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece. michaelides@freemail.gr
Clinical Cardiology
|February 18, 2010
Summary
Adding right-sided chest leads (V(3)R-V(5)R) to exercise tests significantly improves the detection of restenosis after percutaneous coronary intervention (PCI) in the right coronary artery or left circumflex artery.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Exercise Physiology
Background:
- Standard exercise testing can be enhanced by incorporating right-sided chest leads (V(3)R-V(5)R).
- Previous reports suggest improved diagnostic utility with these additional leads.
Purpose of the Study:
- To evaluate the improvement in detecting restenosis using V(3)R-V(5)R leads during exercise testing.
- Focus on asymptomatic patients who underwent percutaneous coronary intervention (PCI) in the right coronary artery (RCA) and/or left circumflex (LCX) artery.
Main Methods:
- 172 patients undergoing PCI in RCA or LCX were studied.
- Treadmill tests were performed pre-PCI and six months post-PCI, with arteriography to detect restenosis.
- Exercise recordings included standard 12-leads plus V(3)R-V(5)R leads.
Main Results:
- Restenosis was detected in 14 patients (8 RCA, 3 LCX, 3 both).
- Sensitivity, specificity, positive prognostic value, and accuracy of exercise testing improved significantly with V(3)R-V(5)R leads (e.g., accuracy 95% vs 78%).
- Maximal exercise-induced ST-segment deviation decreased in V(3)R-V(5)R leads post-PCI (P < .01).
Conclusions:
- The addition of V(3)R-V(5)R leads enhances the diagnostic capability of standard exercise testing.
- This improvement is specifically noted in detecting silent ischemia due to restenosis in patients post-PCI of the RCA or LCX.
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