Is exercise-induced U-wave inversion predictive of proximal left anterior descending coronary artery disease?

A 66-year-old patient with a recent history of chest pain was submitted to exercise test. The rest electrocardiogram was normal, but during effort, a striking U-wave inversion in the chest leads occurred, not associated with any ST-segment change. Coronary angiogram demonstrated a severe proximal narrowing of the left anterior descending coronary artery. Effort-induced U-wave inversion in the precordial leads has long been recognized as a marker of stenosis of the left anterior descending coronary artery, but this pattern is seldom taken into account.