ST elevation in the lead aVR during exercise treadmill testing may indicate left main coronary artery disease.
BACKGROUND
exercise treadmill testing (ETT) is the most widely used method for evaluating patients with coronary artery disease. Predicting the left main coronary artery (LMCA) disease before invasive procedures is very important in risk assessment because of its severe clinical outcome.


OBJECTIVE
To examine whether ST elevation in lead aVR during ETT may suggest LMCA disease since the lead aVR is the reciprocal lead of LMCA.


METHODS
in this study, 61 patients with positive ETT were included. The study group consisted of 21 patients with ST elevation in lead aVR. Forty patients, also having positive ETT, but without ST elevation in lead aVR comprised the control group. All patients underwent coronary angiography.


RESULTS
coronary angiography in the study group revealed significant LMCA stenosis in 16 (76%) patients, whereas LMCA disease was present in only 3 (8%) patients from the control group. There was no significant coronary artery stenosis in 5 patients in the study group and 12 patients in the control group. Of the 16 patients who had LMCA stenosis, 9 had isolated LMCA disease and 7 had additional stenotic lesions in LAD or circumflex coronary arteries. The sensitivity and specificity of ST segment elevation in lead aVR during ETT was 84% and 88%, respectively. The values of positive and negative predictive value of this finding in diagnosing the presence of LMCA were 76% and 93%, respectively.


CONCLUSIONS
ST segment elevation in lead aVR during ETT may point to a high probability of the presence of LMCA disease.
Ozmen
Namik
N
GMMA Haydarpasa Teaching Hospital, Cardiology Department, Istanbul, Turkey. drnamikozmen@yahoo.com
Yiginer
Omer
O
Uz
Omer
O
Kardesoglu
Ejder
E
Aparci
Mustafa
M
Isilak
Zafer
Z
Cingozbay
Bekir Yilmaz
BY
Cebeci
Bekir Sitki
BS
Kocum
Halil Tolga
HT
D000328:Adult; D000368:Aged; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000175:diagnosis*; D003331:Coronary Vessels / Q000473:pathology*; D004562:Electrocardiography / Q000379:methods; D005080:Exercise Test; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011044:Poland; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D012680:Sensitivity and Specificity