The influence of lead strength on the S-T changes with exercise electrocardiography (correlative study with coronary...

The contribution of relative lead strength to S-T segment depression amplitude during exercise was evaluated in 98 patients who had both a treadmill stress test and a coronary arteriogram. This was accomplished by constructing an exercise S-T depression to R wave ratio (S-T/R) and then relating these ratios to the extent of coronary disease found with arteriography. The additional criterion of 1 mm S-T depression for the bipolar V5 and 0.5 mm for the late unipolar V5 was also reviewed. These criteria were then compared to the sensitivity and specificity of the usual 1 mm S-T depression criterion. The S-T/R ratio of 0.04 improved the detection of significant coronary disease over the usual criteria. The ratio of 0.1 was effective in avoiding false positive tests but lacked sensitivity. This would suggest that strong lead systems may give false positive S-T changes with exercise. The use of 0.5 mm depression as abnormal for the post-exercise unipolar V5 improved sensitivity without loss of specificity over the usual criteria of 1 mm S-T depression criteria. This may be a reflection of the voltage differences between the bipolar lead and the unipolar lead in these two lead systems. It is concluded that lead strength must be considered when evaluating the S-T response to exercise.