Diagnostic and Prognostic Value of Lead aVR During Exercise Testing in Patients Suspected of Having Myocardial Ischemia
| Autor: | Christian Mueller, Roger Abächerli, Christian Puelacher, Stefan Osswald, Tobias Reichlin, Karin Wildi, Ramun Schmid, Remo Leber, Nicolas Schaerli, Jasper Boeddinghaus, Dayana Flores Widmer, Patrick Badertscher, Damian Wild, Maria Rubini Gimenez, Raphael Twerenbold, Michael J. Zellweger, Germaine Sunier, Philipp Reddiess, Samyut Shrestha, Ivo Strebel, Gil Pretre, Max Wagener, Thomas Nestelberger, Zaid Sabti, Ursina Honegger |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Male
Technetium Tc 99m Sestamibi medicine.medical_specialty Stress testing Myocardial Ischemia Ischemia Perfusion scanning 030204 cardiovascular system & hematology Coronary Angiography 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans cardiovascular diseases 030212 general & internal medicine Myocardial infarction Lead (electronics) Depression (differential diagnoses) Aged Tomography Emission-Computed Single-Photon business.industry Middle Aged Prognosis medicine.disease Confidence interval Exercise Test Cardiology Female Radiopharmaceuticals Cardiology and Cardiovascular Medicine business Mace |
| Zdroj: | The American Journal of Cardiology. 119:959-966 |
| ISSN: | 0002-9149 |
| Popis: | 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 V 5 . 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 V 5 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 V 5 differed significantly among patients with and without ischemia (p 5 (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 V 5 , 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 5 and clinical factors and also predicts MACE during follow-up. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect