Diagnostic and Prognostic Value of Lead aVR During Exercise Testing in Patients Suspected of Having Myocardial Ischemia
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Diagnostic and Prognostic Value of Lead aVR During Exercise Testing in Patients Suspected of Having Myocardial Ischemia. / Wagener, Max; Abächerli, Roger; Honegger, Ursina; Schaerli, Nicolas; Prêtre, Gil; Twerenbold, Raphael; Puelacher, Christian; Sunier, Germaine; Reddiess, Philipp; Rubini Gimenez, Maria; Wildi, Karin; Boeddinghaus, Jasper; Nestelberger, Thomas; Badertscher, Patrick; Sabti, Zaid; Schmid, Ramun; Leber, Remo; Widmer, Dayana Flores; Shrestha, Samyut; Strebel, Ivo; Wild, Damian; Osswald, Stefan; Zellweger, Michael; Mueller, Christian; Reichlin, Tobias.
In: AM J CARDIOL, Vol. 119, No. 7, 01.04.2017, p. 959-966.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Diagnostic and Prognostic Value of Lead aVR During Exercise Testing in Patients Suspected of Having Myocardial Ischemia
AU - Wagener, Max
AU - Abächerli, Roger
AU - Honegger, Ursina
AU - Schaerli, Nicolas
AU - Prêtre, Gil
AU - Twerenbold, Raphael
AU - Puelacher, Christian
AU - Sunier, Germaine
AU - Reddiess, Philipp
AU - Rubini Gimenez, Maria
AU - Wildi, Karin
AU - Boeddinghaus, Jasper
AU - Nestelberger, Thomas
AU - Badertscher, Patrick
AU - Sabti, Zaid
AU - Schmid, Ramun
AU - Leber, Remo
AU - Widmer, Dayana Flores
AU - Shrestha, Samyut
AU - Strebel, Ivo
AU - Wild, Damian
AU - Osswald, Stefan
AU - Zellweger, Michael
AU - Mueller, Christian
AU - Reichlin, Tobias
N1 - Copyright © 2017 Elsevier Inc. All rights reserved.
PY - 2017/4/1
Y1 - 2017/4/1
N2 - 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 1,596 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 end point 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 end point. 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 receiver operating characteristic curve was highest 2 minutes into recovery and similar in aVR and V5 (0.62, 95% confidence interval CI 0.60 to 0.65 vs 0.60, 95% confidence interval 0.58 to 0.63, p = 0.08 for comparison). In multivariate analysis, ST changes in lead aVR, but not lead V5, contributed independent diagnostic information on top of clinical parameters and manual electrocardiographic 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.
AB - 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 1,596 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 end point 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 end point. 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 receiver operating characteristic curve was highest 2 minutes into recovery and similar in aVR and V5 (0.62, 95% confidence interval CI 0.60 to 0.65 vs 0.60, 95% confidence interval 0.58 to 0.63, p = 0.08 for comparison). In multivariate analysis, ST changes in lead aVR, but not lead V5, contributed independent diagnostic information on top of clinical parameters and manual electrocardiographic 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.
KW - Aged
KW - Coronary Angiography
KW - Exercise Test
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Ischemia/diagnosis
KW - Prognosis
KW - Radiopharmaceuticals
KW - Technetium Tc 99m Sestamibi
KW - Tomography, Emission-Computed, Single-Photon
U2 - 10.1016/j.amjcard.2016.11.056
DO - 10.1016/j.amjcard.2016.11.056
M3 - SCORING: Journal article
C2 - 28215415
VL - 119
SP - 959
EP - 966
JO - AM J CARDIOL
JF - AM J CARDIOL
SN - 0002-9149
IS - 7
ER -
