title: Prevalence and Associated Clinical Characteristics of Exercise-Induced ST-Segment Elevation in Lead aVR.
abstract: BACKGROUND
  Exercise-induced ST-segment elevation (STE) in lead aVR may be an important indicator of prognostically important coronary artery disease (CAD). However, the prevalence and associated clinical features of exercise-induced STE in lead aVR among consecutive patients referred for exercise stress electrocardiography (ExECG) is unknown.
  
  
  METHODS
  All consecutive patients receiving a Bruce protocol ExECG for the diagnosis of CAD at a tertiary care academic center were included over a two-year period. Clinical characteristics, including results of coronary angiography, were compared between patients with and without exercise-induced STE in lead aVR.
  
  
  RESULTS
  Among 2227 patients undergoing ExECG, exercise-induced STE ≥1.0mm in lead aVR occurred in 3.4% of patients. Patients with STE in lead aVR had significantly lower Duke Treadmill Scores (DTS) (-0.5 vs. 7.0, p<0.01) and a higher frequency of positive test results (60.2% vs. 7.3%, p<0.01). Furthermore, patients with STE in lead aVR were more likely to undergo subsequent cardiac catheterization than those without STE in lead aVR (p<0.01, odds ratio = 4.2).
  
  
  CONCLUSIONS
  Among patients referred for ExECG for suspected CAD, exercise-induced STE in lead aVR was associated with a higher risk DTS, an increased likelihood of a positive ExECG, and referral for subsequent coronary angiography. These results suggest that exercise-induced STE in lead aVR may represent a useful ECG feature among patients undergoing ExECG in the risk stratification of patients.
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: James
authors.identifier: http://orcid.org/0000-0003-1093-1792
authors.initials: J
authors.lastname: McKinney
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Ian
authors.initials: I
authors.lastname: Pitcher
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.|Duke Clinical Research Institute, Durham, North Carolina, United States of America.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Fordyce
authors.affiliation: Clinical Research Unit, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.
authors.forename: Masoud
authors.initials: M
authors.lastname: Yousefi
authors.affiliation: National University Heart Centre, Singapore.
authors.forename: Tee Joo
authors.initials: TJ
authors.lastname: Yeo
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.|Division of Cardiology, St Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Ignaszewski
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Saul
authors.initials: S
authors.lastname: Isserow
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.|Division of Cardiology, St Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Sammy
authors.initials: S
authors.lastname: Chan
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.|Division of Cardiology, St Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Krishnan
authors.initials: K
authors.lastname: Ramanathan
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.|Division of Cardiology, St Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Taylor
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000503:physiopathology*; D004562:Electrocardiography / Q000379:methods*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged