Usefulness of exercise-induced ST-segment depression in the inferior leads during exercise testing as a marker for coronary artery disease

Cres P. Miranda, James Liu, A. Kádár, A. Jánosi, Jeffrey Froning, Kenneth G. Lehmann, Victor F. Froelicher

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Multiple lead systems are shown to have a higher sensitivity than that of single leads for detecting coronary artery disease (CAD) during exercise testing, but the value of ST-segment depression isolated to the inferior leads is questionable. To ascertain the diagnostic accuracy of inferior limb lead II compared with that of precordial lead V5, a retrospective analysis of 173 men was performed (108 in a training population and 65 in a validation cohort). All patients had a standard exercise test and underwent diagnostic coronary angiography within 15 days of the exercise test (range 1 to 65). Sixty-three patients had ≥ 1 coronary stenoses ≥70%, or left main lesion ≥50%, whereas 45 patients in the training population did not. Exclusion criteria were female sex, left ventricular hypertrophy, left bundle branch block or resting ST-segment depression on the baseline electrocardiogram, previous myocardial infarction or revascularization procedures, and any significant valvular or congenital heart disease. Lead V5 had a better combination of sensitivity (65%) and specificity (84%) (chi-square = 24.11; p <0.001) than that of lead II (sensitivity 71%, specificity 44%) (chi-square = 2.25; p = 0.13) at a single cut point, and this improved specificity was substantial (95% confidence interval for observed difference 22 to 58%). Receiver-operating characteristic curve analysis also revealed that lead V5 (area = 0.759) was markedly superior to lead II (area = 0.582) over multiple cut points (z = 3.032; 2p = 0.002). In fact, the area under the lead II curve (0.582) was not significantly >0.50 (z = 1.465; p = 0.07), suggesting that for the identification of CAD, isolated ST-segment depression in lead II is unreliable. In patients with normal electrocardiograms, precordial lead V5 is a better marker for CAD during exercise testing than is limb lead II. Exercise-induced ST-segment depression isolated to the inferior leads is of little value.

Original languageEnglish
Pages (from-to)303-307
Number of pages5
JournalThe American journal of cardiology
Volume69
Issue number4
DOIs
Publication statusPublished - Feb 1 1992

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Coronary Artery Disease
Exercise
Exercise Test
Electrocardiography
Extremities
Myocardial Revascularization
Bundle-Branch Block
Coronary Stenosis
Left Ventricular Hypertrophy
Lead
Coronary Angiography
Population
Myocardial Infarction
Sensitivity and Specificity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Usefulness of exercise-induced ST-segment depression in the inferior leads during exercise testing as a marker for coronary artery disease. / Miranda, Cres P.; Liu, James; Kádár, A.; Jánosi, A.; Froning, Jeffrey; Lehmann, Kenneth G.; Froelicher, Victor F.

In: The American journal of cardiology, Vol. 69, No. 4, 01.02.1992, p. 303-307.

Research output: Contribution to journalArticle

Miranda, Cres P. ; Liu, James ; Kádár, A. ; Jánosi, A. ; Froning, Jeffrey ; Lehmann, Kenneth G. ; Froelicher, Victor F. / Usefulness of exercise-induced ST-segment depression in the inferior leads during exercise testing as a marker for coronary artery disease. In: The American journal of cardiology. 1992 ; Vol. 69, No. 4. pp. 303-307.
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abstract = "Multiple lead systems are shown to have a higher sensitivity than that of single leads for detecting coronary artery disease (CAD) during exercise testing, but the value of ST-segment depression isolated to the inferior leads is questionable. To ascertain the diagnostic accuracy of inferior limb lead II compared with that of precordial lead V5, a retrospective analysis of 173 men was performed (108 in a training population and 65 in a validation cohort). All patients had a standard exercise test and underwent diagnostic coronary angiography within 15 days of the exercise test (range 1 to 65). Sixty-three patients had ≥ 1 coronary stenoses ≥70{\%}, or left main lesion ≥50{\%}, whereas 45 patients in the training population did not. Exclusion criteria were female sex, left ventricular hypertrophy, left bundle branch block or resting ST-segment depression on the baseline electrocardiogram, previous myocardial infarction or revascularization procedures, and any significant valvular or congenital heart disease. Lead V5 had a better combination of sensitivity (65{\%}) and specificity (84{\%}) (chi-square = 24.11; p <0.001) than that of lead II (sensitivity 71{\%}, specificity 44{\%}) (chi-square = 2.25; p = 0.13) at a single cut point, and this improved specificity was substantial (95{\%} confidence interval for observed difference 22 to 58{\%}). Receiver-operating characteristic curve analysis also revealed that lead V5 (area = 0.759) was markedly superior to lead II (area = 0.582) over multiple cut points (z = 3.032; 2p = 0.002). In fact, the area under the lead II curve (0.582) was not significantly >0.50 (z = 1.465; p = 0.07), suggesting that for the identification of CAD, isolated ST-segment depression in lead II is unreliable. In patients with normal electrocardiograms, precordial lead V5 is a better marker for CAD during exercise testing than is limb lead II. Exercise-induced ST-segment depression isolated to the inferior leads is of little value.",
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