Prevalence and Associated Clinical Characteristics of Exercise-Induced ST-Segment Elevation in Lead aVR.

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

Descriptive characteristics of the cohort (patients referred for exercise stress testing for the indication “detection of coronary artery disease”).

<p>Descriptive characteristics of the cohort (patients referred for exercise stress testing for the indication “detection of coronary artery disease”).</p

Patient flow diagram.

<p>(LVH, left ventricular hypertrophy; IVCD, interventricular conduction delay; LBBB, left bundle branch block).</p

Coronary anatomy amongst those undergoing clinically indicated cardiac catheterization.

<p>Coronary anatomy amongst those undergoing clinically indicated cardiac catheterization.</p

Clinical referral for cardiac catheterization within six months of exercise testing.

<p>Clinical referral for cardiac catheterization within six months of exercise testing.</p

Exercise test parameters in patients with and without horizontal or upsloping ST-segment elevation ≥1.0mm in lead AVR.

<p>Exercise test parameters in patients with and without horizontal or upsloping ST-segment elevation ≥1.0mm in lead AVR.</p