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Volume 341:208-210 July 15, 1999 Number 3
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Exercise Electrocardiography with Right Precordial Leads

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 by Wellens, H. J.J.
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 by Michaelides, A. P.
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To the Editor: The key to the validity of any study of a diagnostic test is a systematic comparison with an accepted gold standard. Using the coronary angiogram as the gold standard, Michaelides et al. (Feb. 4 issue)1 conclude that the use of right-sided leads improves the diagnostic performance of the exercise electrocardiogram.

Most studies of exercise electrocardiography that use coronary angiography as a gold standard suffer from a sequential workup bias: the decision whether or not to perform coronary angiography rests in the hands of clinicians who are aware of the results of exercise electrocardiography. Patients with normal results . . . [Full Text of this Article]

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