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Localizing coronary artery obstructions with the exercise treadmill test

D B Mark, M A Hlatky, K L Lee

    Annals of Internal Medicine
    |January 1, 1987
    PubMed

    Insights

    ST elevation during exercise tests reliably indicates coronary artery lesions, unlike ST depression which is not a reliable indicator. This finding aids in diagnosing coronary artery disease location.

    Area of Science:

    • Cardiology
    • Diagnostic Imaging
    • Exercise Physiology

    Background:

    • Exercise stress testing is crucial for diagnosing coronary artery disease (CAD).
    • Interpreting electrocardiogram (ECG) changes during exercise, specifically ST segment shifts, is key to localizing coronary lesions.
    • The diagnostic value of ST depression versus ST elevation in pinpointing lesion location requires further clarification.

    Purpose of the Study:

    • To evaluate the reliability of ST segment depression and elevation patterns during exercise testing for identifying the location of coronary artery lesions.
    • To differentiate the diagnostic utility of ST elevation versus ST depression in patients with one-vessel coronary artery disease.

    Main Methods:

    • A study of 452 consecutive patients with one-vessel coronary artery disease who underwent treadmill testing.
    • Classification of exercise-induced ST segment changes into elevation or depression.
    • Analysis of ST changes based on the specific ECG lead groups involved.

    Main Results:

    • ST depression during exercise was commonly observed in leads V5 or V6, irrespective of the affected coronary artery.
    • Anterior ST elevation accurately predicted left anterior descending coronary artery disease in 93% of cases.
    • Inferior ST elevation accurately predicted lesions in or proximal to the posterior descending artery in 86% of cases.
    • Anterior ST elevation patterns correlated with stenosis severity and occlusion status of the left anterior descending artery.

    Conclusions:

    • ST elevation during exercise testing, though infrequent, serves as a dependable indicator for the location of underlying coronary artery lesions.
    • ST depression during exercise testing is not a reliable indicator for localizing coronary artery lesions.

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