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.
Hypothesis: 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 V5R (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