@article{3083596,
    title = "Significance of exercise-induced ST changes in leads aVR, V-5, and V-1.
Discrimination of patients with single- or multivessel coronary artery
disease",
    author = "Michaelides, AP and Psomadaki, ZD and Aigyptiadou, MNK and Richter, DJ and and Andrikopoulos, GK and Dilaveris, PE and Tsioufis, K and Tousoulis, D and and Stefanadis, CI and Toutouzas, PK",
    journal = "Clinical Cardiology",
    year = "2003",
    volume = "26",
    number = "5",
    pages = "226-230",
    publisher = "Wiley",
    issn = "0160-9289, 1932-8738",
    doi = "10.1002/clc.4960260506",
    keywords = "exercise testing; ST-segment deviation; lead V-1; lead aVR; coronary
artery disease; left anterior descending artery stenosis",
    abstract = "Background: It is known that exercise-induced ST-segment elevation in
lead V-1 (V-1-E) detects left anterior descending (LAD) stenosis. It was
also postulated that ST elevation in aVR and simultaneous ST depression
in V-5 (aVR-E + V-5-D) is a marker of ischemia due to significant
stenosis of the LAD in patients with single-vessel disease.
Hypothesis: This study was undertaken to investigate the significance of
the concomitant appearance of both electrocardiographic (ECG) ischemic
markers, and of each of them alone during exercise, to detect either LAD
stenosis as single-vessel coronary artery disease (CAD), or multivessel
CAD involving LAD stenosis.
Methods: A total of 196 consecutive patients (152 men and 44 women, mean
age 54 7 years) with at least one of these ECG markers, who underwent
treadmill exercise testing with the Bruce protocol and coronary
arteriography, were studied.
Results: Patients were divided into three groups. In Group A (83
patients with V-1-E + aVR-E & V-5-D), 93% of patients with
single-vessel disease had significant LAD stenosis (p < 0.001), whereas
75% of patients with double-vessel disease had significant stenoses of
the LAD and the left circumflex (LCx) coronary arteries (p < 0.01). In
Group B (97 patients with aVR-E & V-5-D but without VI-E), 43% of
patients with single-vessel disease had significant LAD stenosis (p <
0.08), whereas 85% of patients with double-vessel disease had
significant stenoses of the LAD and the right coronary artery (RCA) (p <
0.01). In Group C (16 patients with only V-1-E), 60% of patients with
single-vessel disease had significant LAD stenosis (p < 0.05), whereas
75% of patients with double-vessel disease had significant LAD and LCx
stenoses (p < 0.05).
Conclusions: The concomitant appearance of exercise-induced ST elevation
in lead V-1, ST elevation in lead aVR, and ST depression in lead V-5, as
well as the isolated appearance of ST elevation in lead V-1 detect
significant LAD stenosis as single-vessel disease, or significant
stenoses of LAD and LCx arteries in patients with double-vessel disease,
whereas the appearance of ST elevation in aVR & ST depression in V-5
but without ST elevation in V, correlates strongly with significant LAD
and RCA stenoses and usually indicates double-vessel disease."
}