Document Detail

Addition of right-sided and posterior precordial leads during stress testing.
MedLine Citation:
PMID:  14661004     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Exercise treadmill testing has limited sensitivity for the detection of coronary artery disease, frequently requiring the addition of imaging modalities to enhance the predictive value of the test. Recently, there has been interest in using nonstandard electrocardiographic (ECG) leads during exercise testing. METHODS:We consecutively enrolled all patients undergoing exercise myocardial imaging with four additional leads recorded (V4R, V7, V8, and V9). The test characteristics of the 12-lead, the 15-lead (12-lead, V7, V8, V9), and the 16-lead (12-lead, V4R, V7, V8, V9) ECGs were compared with stress imaging in all patients. In the subset of patients who underwent angiography within 60 days of stress testing, these lead arrays were compared with the catheterization findings. RESULTS: There were 727 subjects who met entry criteria. The mean age was 58.5 +/- 12.3 years, and 366 (50.3%) were women. Pretest probability for disease was high in 241 (33.1%), intermediate in 347 (47.7%), and low in 139 (19.1%). A total of 166 subjects had an abnormal 12-lead ECG during exercise. The addition of 3 posterior leads to the standard 12-lead ECG resulted in 7 additional subjects having an abnormal electrocardiographic response to exercise. The addition of V4R resulted in only 1 additional patient having an abnormal ECG during exercise. The sensitivity of the ECG for detecting ischemia as determined by stress imaging was 36.6%, 39.2%, and 40.0% (P = NS) for the 12-lead, 15-lead, and 16-lead ECGs, respectively. In those with catheterization data (n = 123), the sensitivity for determining obstructive coronary artery disease was 43.5%, 45.2%, and 45.2% (P = NS) for the 12-lead, 15-lead, and 16-lead ECGs, respectively. The sensitivity of imaging modalities was 77.4% when compared with catheterization. CONCLUSIONS: In patients undergoing stress imaging studies, the addition of right-sided and posterior leads did not significantly increase the sensitivity of the ECG for the detection of myocardial ischemia. Additional leads should not be used to replace imaging modalities for the detection of coronary artery disease.
Eric A Shry; Robert E Eckart; James L Furgerson; Karl C Stajduhar; Richard A Krasuski
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American heart journal     Volume:  146     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2003 Dec 
Date Detail:
Created Date:  2003-12-08     Completed Date:  2004-01-13     Revised Date:  2006-02-27    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1090-4     Citation Subset:  AIM; IM    
Cardiology Division, Brooke Army Medical Center, San Antonio, Tex 78234-6200, USA. Eric.Shry@AMEDD.ARMY.MIL
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MeSH Terms
Coronary Disease / diagnosis*,  physiopathology
Coronary Stenosis / diagnosis,  physiopathology
Electrocardiography / instrumentation,  methods*
Equipment Design
Exercise Test / instrumentation,  methods*
Heart Catheterization
Middle Aged
Myocardial Ischemia / diagnosis,  physiopathology
Sensitivity and Specificity

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