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

Samad Ghaffari1, Reza Asadzadeh1, Arezou Tajlil1

  • 1Cardiovascular Research Center, Tabriz University of Medicine, Tabriz, Iran.

Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc
|May 26, 2016
PubMed

Insights

ST elevation in lead aVR during exercise stress tests is highly sensitive for detecting left main and proximal left anterior descending artery stenosis. Combining lead aVR with lead V1 improves specificity for identifying coronary artery disease.

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Exercise Physiology

Background:

  • The diagnostic value of electrocardiographic (ECG) changes during exercise tolerance testing (ETT) for identifying coronary artery occlusion remains incompletely understood.
  • This study investigated the utility of ST-segment elevation in specific ECG leads during exercise for detecting significant coronary artery stenosis.

Purpose of the Study:

  • To determine the role of ST-segment elevation in leads aVR and V1 during exercise stress testing in identifying left main coronary artery (LMCA) and proximal left anterior descending (LAD) artery stenosis.
  • To assess the sensitivity and specificity of ST-segment elevation in leads aVR and V1 for detecting these critical coronary artery lesions.

Main Methods:

  • Retrospective analysis of ST-segment changes during ETT in 230 patients who subsequently underwent diagnostic coronary angiography.
  • Correlation of ST-segment elevation in leads aVR, V1, and combined leads (aVR + V1) with the presence and location of coronary artery stenosis.
  • Evaluation of ST-segment depression in other leads in conjunction with ST elevation in aVR and V1 patterns.

Main Results:

  • ST-segment elevation in lead aVR during ETT was significantly associated with both LMCA and proximal LAD artery stenosis (P < 0.001).
  • A ST elevation of ≥1 mm in lead aVR demonstrated high sensitivity (100% for LMCA, 94.3% for proximal LAD) but lower specificity (33.5% for LMCA, 26.6% for proximal LAD).
  • Combining ST elevation in leads aVR and V1 yielded a sensitivity of 74.4% for LMCA and 65.9% for proximal LAD stenosis, with improved specificity (68.5% for LMCA, 64.4% for proximal LAD).

Conclusions:

  • ST-segment elevation in lead aVR during exercise stress testing is a highly sensitive indicator for detecting left main and proximal left anterior descending artery stenosis.
  • Incorporating ST elevation in lead V1 alongside lead aVR enhances the specificity of detecting these critical coronary lesions, albeit with a reduction in sensitivity.
Abstract

Keywords:
coronary angiographycoronary artery diseaseelectrocardiographyexercise test

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