Ueshima Kenji, Kobayashi Noboru, Kamata Junya, Saitoh Masahiko, Yamazaki Takuya, Chiba Ikuo, Hiramori Katsuhiko
Second Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
Clin Cardiol. 2004 Feb;27(2):101-5. doi: 10.1002/clc.4960270214.
It is still unknown whether or not the additional right precordial leads (RPL) during exercise testing contribute to detection of coronary artery disease (CAD).
The aim of this study was to evaluate the RPL during exercise testing for the detection of CAD.
The study included 157 consecutive patients (116 men and 41 women, mean age 66 years) suspected of having CAD, who underwent conclusive treadmill exercise testing (heart rate reached at least 85% of the predicted maximum or positive electrocardiogram [ECG] changes were exhibited) and coronary angiography. During exercise testing, the ECG was recorded with the standard 12 leads and 4 RPL (V3R, V4R, V5R, V6R).
Of the 157 patients, 67 had CAD (> 75% stenosis in at least one major coronary artery), and 64 had positive ST changes in the standard ECG leads during exercise testing. Using the conventional 12-lead method, sensitivity and specificity were 76 and 86%, respectively. Only three patients exhibited positive changes in the RPL leads; all had > 0.1 mV ST elevation in one of the RPL leads with > 0.1 mV ST elevation in aVR. Two of these patients had significant right coronary artery lesions and the other had a lesion of the left anterior descending artery which perfused the inferior as well as the anteroseptal area. In the standard 12 leads, one of the patients with an abnormal RPL and a right coronary lesion was negative, while the other two patients were positive. Combining RPL with the conventional 12-lead method, sensitivity and specificity were 78 and 86%, respectively. Therefore, RPL did not improve the accuracy of the exercise ECG.
The use of RPL during exercise testing may contribute to the detection of ischemia perfused by the right coronary artery; however, it does not improve the diagnostic accuracy of the exercise test.
运动试验期间增加右胸前导联（RPL）是否有助于检测冠状动脉疾病（CAD）仍不清楚。
本研究的目的是评估运动试验期间的RPL对CAD的检测作用。
该研究纳入了157例连续的疑似CAD患者（116例男性和41例女性，平均年龄66岁），这些患者接受了确定性平板运动试验（心率至少达到预测最大值的85%或出现阳性心电图[ECG]变化）和冠状动脉造影。在运动试验期间，用标准12导联和4个RPL（V3R、V4R、V5R、V6R）记录ECG。
157例患者中，67例患有CAD（至少一支主要冠状动脉狭窄>75%），64例在运动试验期间标准ECG导联出现ST段阳性改变。采用传统12导联方法，敏感性和特异性分别为76%和86%。只有3例患者在RPL导联出现阳性改变；所有患者在一个RPL导联有>0.1 mV的ST段抬高，同时aVR导联也有>0.1 mV的ST段抬高。其中2例患者有明显的右冠状动脉病变，另1例患者有左前降支病变，该病变供血至下壁及前间隔区域。在标准12导联中，1例RPL异常且有右冠状动脉病变的患者为阴性，而另外2例患者为阳性。将RPL与传统12导联方法相结合，敏感性和特异性分别为78%和86%。因此，RPL并未提高运动ECG的准确性。
运动试验期间使用RPL可能有助于检测右冠状动脉供血区域的缺血；然而，它并未提高运动试验的诊断准确性。
