title: Exercise test predictors of severe coronary artery disease: Role of ST-segment elevation in lead aVR.
abstract: BACKGROUND
  The role of exercise stress test (EST)-induced ST-segment elevation (STE) in electrocardiographic lead aVR in predicting severe coronary artery disease (CAD) is controversial.
  
  
  OBJECTIVE
  Assessment of lead aVR during EST can be helpful to identify patients with severe CAD.
  
  
  METHODS
  We performed maximal EST in 200 patients undergoing coronary angiography for suspect of CAD. Four angiographic findings of severe CAD were considered: (1) left main (LM) disease; (2) LM or equivalent LM (LM/EQLM) disease; (3) LM or proximal left anterior descending (LAD) artery (LM/proxLAD) disease; and (4) LM or 3-vessel (LM/3V) disease.
  
  
  RESULTS
  LM, LM/EQLM, LM/proxLAD, and LM/3V disease were shown in 6 (3%), 13 (6.5%), 33 (16.5%), and 27 (13.5%) patients, respectively. EST-induced STE in aVR occurred in 41 patients (20.5%). ST-segment depression (STD) in ≥5 leads was the only predictor of LM stenosis (odds ratio [OR]: 6.18, 95% confidence interval [CI]: 1.19-32.2, P = 0.03) and the most significant variable associated with LM/proxLAD stenosis (OR: 4.73, 95% CI: 2.0-11.2, P = 0.0001); maximal STD ≥3 mm was the most significant variable associated with LM/EQLM (OR: 7.58, 95% CI: 2.31-24.9, P = 0.001) and LM/3V (OR: 3.86, 95% CI: 1.47-10.1, P = 0.006) CAD. EST-induced STE in aVR was associated with LM/proxLAD disease only (OR: 3.23, 95% CI: 1.44-7.24, P = 0.004). At multivariate analysis, STD in ≥5 leads was the only independent predictor of LM/proxLAD disease (OR: 3.99, 95% CI: 1.58-10.1, P = 0.003).
  
  
  CONCLUSIONS
  EST-induced STE in lead aVR does not significantly increase the prediction of severe CAD compared with severity and extension of STD as assessed in the other electrocardiographic leads.
authors.affiliation: Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Russo
authors.affiliation: Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Salvatore Emanuele
authors.initials: SE
authors.lastname: Ravenna
authors.affiliation: Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: De Vita
authors.affiliation: Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Aurigemma
authors.affiliation: Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Lamendola
authors.affiliation: Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Gaetano Antonio
authors.initials: GA
authors.lastname: Lanza
authors.affiliation: Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004562:Electrocardiography / Q000379:methods*; D004566:Electrodes; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
keywords: Exercise testing and exercise physiology; Ischemic heart disease; Lead aVR; Standard electrocardiography; chronic