Details

Autor(en) / Beteiligte

• Wagener, Max, MD
• Abächerli, Roger, PhD
• Honegger, Ursina, MS
• Schaerli, Nicolas, MD
• Prêtre, Gil, MD
• Twerenbold, Raphael, MD
• Puelacher, Christian, MD
• Sunier, Germaine
• Reddiess, Philipp
• Rubini Gimenez, Maria, MD
• Wildi, Karin, MD
• Boeddinghaus, Jasper, MD
• Nestelberger, Thomas, MD
• Badertscher, Patrick, MD
• Sabti, Zaid, MD
• Schmid, Ramun, MSE
• Leber, Remo, MSE
• Widmer, Dayana Flores, MD
• Shrestha, Samyut, MD
• Strebel, Ivo, MS
• Wild, Damian
• Osswald, Stefan
• Zellweger, Michael
• Mueller, Christian
• Reichlin, Tobias

Titel

Diagnostic and Prognostic Value of Lead aVR During Exercise Testing in Patients Suspected of Having Myocardial Ischemia

Ist Teil von

• The American journal of cardiology, 2017-04, Vol.119 (7), p.959-966

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2017

Quelle

MEDLINE

Beschreibungen/Notizen

• Abstract We aimed to assess the diagnostic and prognostic value of ST-segment deviation in aVR, a lead often ignored in clinical practice, during exercise testing and to compare it to the most widely used criterion of ST-segment depression in V5. We enrolled 1596 patients with suspected myocardial ischemia referred for nuclear perfusion imaging undergoing bicycle stress testing. ST-segment amplitudes in leads aVR and V5 were automatically measured. The presence of inducible myocardial ischemia was the diagnostic endpoint and adjudicated based on nuclear perfusion imaging and coronary angiography. Major adverse cardiac events (MACE) during 2 years of follow-up including death, acute myocardial infarction and coronary revascularization were the prognostic endpoint. Exercise induced myocardial ischemia was detected in 470 patients (29%). Median ST-amplitudes for leads aVR and V5 differed significantly among patients with and without ischemia (p<0.01). The diagnostic accuracy of ST-changes for myocardial ischemia as quantified by the area under the ROC curve was highest 2 minutes into recovery and similar in aVR and V5 (0.62 (95% CI, 0.60-0.65) vs. 0.60 (95% CI, 0.58-0.63), p=0.08 for comparison). In multivariable analysis, ST-changes in lead aVR, but not lead V5 contributed independent diagnostic information on top of clinical parameters and manual ECG-interpretation. Within 2 years of follow-up, MACE occurred in 33% of patients with ST-elevations in aVR and in 16% without (p<0.001). In conclusion, ST-elevation in lead aVR during exercise testing indicates inducible myocardial ischemia independently of ST-depressions in lead V5 and clinical factors, and also predicts MACE during follow-up.