Precordial electrocardiographic mapping after exercise in the diagnosis of coronary artery disease

A technique is described for recording the precordial electrocardiographic body surface map before and after exercise. The technique provides an extra dimension to the conventional exercise electrocardiogram because a measurement can be made of the area and severity of S-T segment changes that are projected onto the front of the chest. Sixteen lead isopotential surface maps were recorded before and after exercise in 109 patients with angina who subsequently underwent coronary arteriography. In addition, exercise electrocardiograms were obtained in 53 of these patients using three orthogonal leads and in all patients using a single chest unipolar chest lead. Precordial surface mapping after exercise was found to have a greater sensitivity (95 percent) than electrocardiography using either the orthogonal leads (68 percent) or a single chest lead (64 percent) (P less than 0.01). The specificity of the three techniques did not differ significantly (P greater than 0.05). The technique of precordial surface mapping after exercise improves the ability to diagnose coronary artery disease and can easily be applied to clinical practice.