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Improved criteria for localization of coronary artery disease from the exercise electrocardiogram
D A Halon1, D Mevorach, M Rodeanu
1Department of Cardiology, Lady Davis Carmel Hospital, Haifa, Israel.
Insights
Electrocardiogram criteria can noninvasively detect coronary artery disease. Specific S-T segment and QRS axis changes in lead V1 help identify left anterior descending artery disease, improving diagnosis.
Area of Science:
- Cardiology
- Medical Diagnostics
Background:
- Coronary artery disease (CAD) diagnosis often requires invasive procedures.
- Noninvasive methods for localizing CAD are crucial for better patient management.
Purpose of the Study:
- To establish improved electrocardiogram (ECG) criteria for noninvasive localization of coronary artery disease.
- To differentiate between left anterior descending (LAD) and other coronary artery disease locations using ECG findings.
Main Methods:
- Analysis of 12-lead computer-averaged rest and exercise ECGs in 44 patients with confirmed single-vessel CAD.
- Evaluation of ECG parameters including S-T segment elevation, T wave amplitude, and mean frontal plane QRS axis (AQRS) shifts.
Main Results:
- Left anterior descending artery disease showed high sensitivity and specificity with S-T segment elevation in lead V1 (71%, 100%), increased T wave amplitude in V1 (88%, 73%), and a leftward AQRS shift (92%, 93%).
- Patients with circumflex or right coronary artery disease lacked S-T segment elevation in V1 and exhibited a rightward AQRS shift.
Conclusions:
- Specific ECG criteria, particularly S-T segment changes and AQRS axis shifts in lead V1, can effectively localize coronary artery disease noninvasively.
- These findings offer a valuable tool for differentiating LAD disease from other coronary artery pathologies, potentially reducing the need for invasive testing.
Abstract:
To derive better criteria for the noninvasive localization of coronary artery disease, a 12-lead computer-averaged rest and exercise electrocardiogram was examined in 44 selected patients (34 men, 10 women) with single-vessel disease who had an exercise test positive for ischemia by established criteria. Left anterior descending disease was characterized by S-T segment elevation (> or = 0.05 mV) in lead V1 [sensitivity (S) 71%, specificity (Sp) 100%], a T wave amplitude increase in V1 (S 88%, Sp 73%) and a leftward shift or no change in mean frontal plane QRS axis (AQRS; S 92%, Sp 93%). Patients with circumflex or right coronary artery disease had no S-T segment elevation in V1 and a rightward shift in the mean frontal plane AQRS.