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Addition of right-sided and posterior precordial leads during stress testing.

Publication ,  Journal Article
Shry, EA; Eckart, RE; Furgerson, JL; Stajduhar, KC; Krasuski, RA
Published in: Am Heart J
December 2003

BACKGROUND: Exercise treadmill testing has limited sensitivity for the detection of coronary artery disease, frequently requiring the addition of imaging modalities to enhance the predictive value of the test. Recently, there has been interest in using nonstandard electrocardiographic (ECG) leads during exercise testing. METHODS: We consecutively enrolled all patients undergoing exercise myocardial imaging with four additional leads recorded (V4R, V7, V8, and V9). The test characteristics of the 12-lead, the 15-lead (12-lead, V7, V8, V9), and the 16-lead (12-lead, V4R, V7, V8, V9) ECGs were compared with stress imaging in all patients. In the subset of patients who underwent angiography within 60 days of stress testing, these lead arrays were compared with the catheterization findings. RESULTS: There were 727 subjects who met entry criteria. The mean age was 58.5 +/- 12.3 years, and 366 (50.3%) were women. Pretest probability for disease was high in 241 (33.1%), intermediate in 347 (47.7%), and low in 139 (19.1%). A total of 166 subjects had an abnormal 12-lead ECG during exercise. The addition of 3 posterior leads to the standard 12-lead ECG resulted in 7 additional subjects having an abnormal electrocardiographic response to exercise. The addition of V4R resulted in only 1 additional patient having an abnormal ECG during exercise. The sensitivity of the ECG for detecting ischemia as determined by stress imaging was 36.6%, 39.2%, and 40.0% (P = NS) for the 12-lead, 15-lead, and 16-lead ECGs, respectively. In those with catheterization data (n = 123), the sensitivity for determining obstructive coronary artery disease was 43.5%, 45.2%, and 45.2% (P = NS) for the 12-lead, 15-lead, and 16-lead ECGs, respectively. The sensitivity of imaging modalities was 77.4% when compared with catheterization. CONCLUSIONS: In patients undergoing stress imaging studies, the addition of right-sided and posterior leads did not significantly increase the sensitivity of the ECG for the detection of myocardial ischemia. Additional leads should not be used to replace imaging modalities for the detection of coronary artery disease.

Duke Scholars

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

December 2003

Volume

146

Issue

6

Start / End Page

1090 / 1094

Location

United States

Related Subject Headings

  • Sensitivity and Specificity
  • Probability
  • Myocardial Ischemia
  • Middle Aged
  • Male
  • Humans
  • Female
  • Exercise Test
  • Equipment Design
  • Electrodes
 

Citation

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Shry, E. A., Eckart, R. E., Furgerson, J. L., Stajduhar, K. C., & Krasuski, R. A. (2003). Addition of right-sided and posterior precordial leads during stress testing. Am Heart J, 146(6), 1090–1094. https://doi.org/10.1016/S0002-8703(03)00513-1
Shry, Eric A., Robert E. Eckart, James L. Furgerson, Karl C. Stajduhar, and Richard A. Krasuski. “Addition of right-sided and posterior precordial leads during stress testing.Am Heart J 146, no. 6 (December 2003): 1090–94. https://doi.org/10.1016/S0002-8703(03)00513-1.
Shry EA, Eckart RE, Furgerson JL, Stajduhar KC, Krasuski RA. Addition of right-sided and posterior precordial leads during stress testing. Am Heart J. 2003 Dec;146(6):1090–4.
Shry, Eric A., et al. “Addition of right-sided and posterior precordial leads during stress testing.Am Heart J, vol. 146, no. 6, Dec. 2003, pp. 1090–94. Pubmed, doi:10.1016/S0002-8703(03)00513-1.
Shry EA, Eckart RE, Furgerson JL, Stajduhar KC, Krasuski RA. Addition of right-sided and posterior precordial leads during stress testing. Am Heart J. 2003 Dec;146(6):1090–1094.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

December 2003

Volume

146

Issue

6

Start / End Page

1090 / 1094

Location

United States

Related Subject Headings

  • Sensitivity and Specificity
  • Probability
  • Myocardial Ischemia
  • Middle Aged
  • Male
  • Humans
  • Female
  • Exercise Test
  • Equipment Design
  • Electrodes