title: Electrocardiographic criteria for detecting coronary artery disease in hypertensive patients with ST-segment changes during exercise testing.
abstract: OBJECTIVE
  It is well known that patients with arterial hypertension frequently present with ischemic electrocardiographic changes during exercise testing without actually having coronary artery disease (CAD). The purpose of this study was to establish additional electrocardiographic criteria during exercise testing for detecting CAD in hypertensive patients with ischemic ST-segment response.
  
  
  METHODS
  Three hundred eighty-two consecutive hypertensive patients (224 males, 58 +/- 8 years) who presented with ischemic electrocardiographic changes during exercise testing and agreed to undergo coronary arteriography were included in the study.
  
  
  RESULTS
  From 382 hypertensive patients undergoing coronary angiography, only 76 (20%) had significant coronary stenosis, whereas 306 (80%) had normal coronary arteries. From 382 patients, 287 (75%) (group A) presented with ST-segment depression during exercise in leads II-III-aVF-V(6), 271 (94%) of which had normal arteries at the angiography. The remaining 95 patients (25%) (group B) of the studied patients presented with ST-segment depression in II-III-aVF and/or V(4) through V(6), 60 (63%) of which had CAD. Furthermore, 251 patients of group A presented with ST-segment depression during the fourth to sixth minute of the recovery period in V(4) through V(6), 247 (98%) of which had normal arteries. Another 28 patients from group B presented with ST-segment depression during the fourth to eighth minute of the recovery period in V(4) through V(6), 22 (79%) of which had significant coronary artery stenosis.
  
  
  CONCLUSIONS
  Hypertensive patients who present with ST-segment depression during exercise in leads II-III-aVF and/or V(4) through V(6) and with a prolonged duration of this depression at the recovery phase (fourth to eighth minute) are more likely to have CAD. Absence of ST-segment depression in V(4) and V(5) at the end of exercise or during the seventh and eighth minute of recovery favors a false-positive result.
authors.affiliation: 1st University Department of Cardiology, Exercise Laboratory, Athens Medical School, Hippokration Hospital, Athens, Greece. michaelides@freemail.gr
authors.forename: Andreas P
authors.initials: AP
authors.lastname: Michaelides
authors.forename: Charalampos I
authors.initials: CI
authors.lastname: Liakos
authors.forename: Leonidas G
authors.initials: LG
authors.lastname: Raftopoulos
authors.forename: Charalambos
authors.initials: C
authors.lastname: Antoniades
authors.forename: Gregory
authors.initials: G
authors.lastname: Vyssoulis
authors.forename: George
authors.initials: G
authors.lastname: Andrikopoulos
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Ioakeimides
authors.forename: Constantinos
authors.initials: C
authors.lastname: Tsioufis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Soulis
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
mesh_terms: D023921:Coronary Stenosis / Q000150:complications* / Q000175:diagnosis*; D004562:Electrocardiography / Q000379:methods*; D005080:Exercise Test; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity