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Previous Volume 340:340-345 February 4, 1999 Number 5 Next

	Full Text PDF Editorial by Wellens, H. J.J. Letters Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Exercise electrocardiography is an imperfect test for the detection of coronary artery disease. We attempted to improve the diagnostic accuracy of exercise testing as a noninvasive method for the detection of coronary artery disease by using a combination of the left and right precordial leads.

Methods We studied 245 patients (218 men and 27 women) ranging from 32 to 74 years of age (mean [±SD], 52±8) who underwent treadmill exercise testing, thallium-201 scintigraphy, and coronary arteriography. During exercise testing, each patient had one electrocardiogram recorded with the standard 12 leads and 3 right precordial leads (V₃R, V₄R, and V₅R), with the results for each set of leads recorded and analyzed separately.

Results On the basis of coronary arteriography, 34 patients had normal coronary arteries, 85 had single-vessel disease, 84 had two-vessel disease, and 42 had three-vessel disease. The sensitivities of the standard 12-lead exercise electrocardiogram, exercise electrocardiography incorporating right precordial leads, and thallium-201 scintigraphy were 52 percent, 89 percent, and 87 percent, respectively, for the detection of single-vessel disease; 71 percent, 94 percent, and 96 percent for the detection of two-vessel disease; 83 percent, 95 percent, and 98 percent for the detection of three-vessel disease; and 66 percent, 92 percent, and 93 percent for the detection of any coronary artery disease. The specificities of the three methods for the detection of any coronary artery disease were 88 percent, 88 percent, and 82 percent, respectively.

Conclusions Use of right precordial leads along with the standard six left precordial leads during exercise electrocardiography greatly improves the sensitivity of exercise testing for the diagnosis of coronary artery disease.

Source Information

From the Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece.

Address reprint requests to Dr. Michaelides at 47 Agiou Gerasimou St., Zografou 15771, Athens, Greece.

Full Text of this Article

Related Letters:

Exercise Electrocardiography with Right Precordial Leads
Lauer M. S., Cole C., Krumholz H. M., Pennell D., Cohen H. E., Smulyan H., Fruehan C. T., Michaelides A. P., Andrikopoulos G. K., Toutouzas P., Wellens H. J.J.
Extract | Full Text  
N Engl J Med 1999; 341:208-210, Jul 15, 1999. Correspondence

Use of Right Precordial Leads during Exercise Testing
Bokhari S., Blood D. K., Bergmann S. R., Michaelides A. P., Andrikopoulos G. K., Toutouzas P. K.
Extract | Full Text  
N Engl J Med 2000; 343:968-969, Sep 28, 2000. Correspondence

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