title: Right-sided chest leads in exercise testing for detection of coronary restenosis.
abstract: BACKGROUND
  The incorporation of right-sided chest leads (V(3)R through V(5)R) into standard exercise testing has been reported to improve its diagnostic utility.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate any improvement in the ability of exercise testing in detecting restenosis, using additional V(3)R through V(5)R leads, in asymptomatic patients undergoing percutaneous coronary intervention (PCI) in the right coronary artery (RCA) or/and left circumflex (LCX).
  
  
  METHODS
  We studied 172 consecutive patients (54 +/- 7 years old, 106 males) undergoing PCI in RCA or/and LCX. A treadmill test had been performed before PCI. Six months later, all patients underwent a second treadmill test and arteriography in order to detect silent ischemia due to restenosis. Recordings during exercise were obtained with the standard 12-leads plus V(3)R through V(5)R.
  
  
  RESULTS
  Out of 172 patients, 106 had stenosis in RCA, 35 in LCX, and 31 in both vessels while 6 months later, restenosis was detected in 8 (for RCA), 3 (for LCX), and 3 (for both vessels) patients respectively. Sensitivity, specificity, positive prognostic value, negative prognostic value, and accuracy of exercise testing performed post PCI were ameliorated using V(3)R through V(5)R (79% vs 57%, 97% vs 80%, 69% vs 21%, 98% vs 95%, and 95% vs 78% respectively, P < .05 for all except negative prognostic value). Maximal exercise-induced ST-segment deviation (in mm) was not changed post PCI in 12 leads (1.4 +/- 0.2 vs 1.5 +/- 0.2, P = NS) while it was decreased in V(3)R through V(5)R (0.2 +/- 0.2 vs 1.2 +/- 0.3, P < .01).
  
  
  CONCLUSIONS
  The addition of V(3)R through V(5)R improves the diagnostic ability of standard exercise testing in detecting silent ischemia due to restenosis in patients undergoing PCI in RCA or/and LCX.
authors.affiliation: Exercise Laboratory, 1st University Department of Cardiology, 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: Charalambos
authors.initials: C
authors.lastname: Antoniades
authors.forename: Polychronis E
authors.initials: PE
authors.lastname: Dilaveris
authors.forename: Eleftherios G
authors.initials: EG
authors.lastname: Tsiamis
authors.forename: Konstantinos P
authors.initials: KP
authors.lastname: Tsioufis
authors.forename: Konstantina D
authors.initials: KD
authors.lastname: Aggeli
authors.forename: Konstantinos P
authors.initials: KP
authors.lastname: Toutouzas
authors.forename: Leonidas G
authors.initials: LG
authors.lastname: Raftopoulos
authors.forename: Christodoulos I
authors.initials: CI
authors.lastname: Stefanadis
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003326:Coronary Circulation; D023903:Coronary Restenosis / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D004562:Electrocardiography; D005080:Exercise Test / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D015607:Stents