GMMA Haydarpasa Teaching Hospital, Cardiology Department, Istanbul, Turkey.
Kardiol Pol. 2010 Oct;68(10):1107-11.
exercise treadmill testing (ETT) is the most widely used method for evaluating patients with coronary artery disease. Predicting the left main coronary artery (LMCA) disease before invasive procedures is very important in risk assessment because of its severe clinical outcome.
To examine whether ST elevation in lead aVR during ETT may suggest LMCA disease since the lead aVR is the reciprocal lead of LMCA.
in this study, 61 patients with positive ETT were included. The study group consisted of 21 patients with ST elevation in lead aVR. Forty patients, also having positive ETT, but without ST elevation in lead aVR comprised the control group. All patients underwent coronary angiography.
coronary angiography in the study group revealed significant LMCA stenosis in 16 (76%) patients, whereas LMCA disease was present in only 3 (8%) patients from the control group. There was no significant coronary artery stenosis in 5 patients in the study group and 12 patients in the control group. Of the 16 patients who had LMCA stenosis, 9 had isolated LMCA disease and 7 had additional stenotic lesions in LAD or circumflex coronary arteries. The sensitivity and specificity of ST segment elevation in lead aVR during ETT was 84% and 88%, respectively. The values of positive and negative predictive value of this finding in diagnosing the presence of LMCA were 76% and 93%, respectively.
ST segment elevation in lead aVR during ETT may point to a high probability of the presence of LMCA disease.
运动平板试验（ETT）是评估冠心病患者最常用的方法。在侵入性操作之前预测左主干冠状动脉（LMCA）疾病对于风险评估非常重要，因为它具有严重的临床后果。
检查在 ETT 期间 aVR 导联的 ST 段抬高是否可能提示 LMCA 疾病，因为 aVR 导联是 LMCA 的对应导联。
在这项研究中，纳入了 61 例 ETT 阳性的患者。研究组包括 21 例 aVR 导联 ST 段抬高的患者。40 例 ETT 阳性但 aVR 导联无 ST 段抬高的患者组成对照组。所有患者均接受冠状动脉造影检查。
研究组冠状动脉造影显示 16 例（76%）患者存在显著的 LMCA 狭窄，而对照组仅 3 例（8%）患者存在 LMCA 疾病。研究组中有 5 例患者和对照组中有 12 例患者无明显冠状动脉狭窄。在 16 例 LMCA 狭窄患者中，9 例为孤立性 LMCA 疾病，7 例存在 LAD 或回旋支冠状动脉的附加狭窄病变。在 ETT 期间 aVR 导联 ST 段抬高的敏感性和特异性分别为 84%和 88%。该发现诊断 LMCA 存在的阳性和阴性预测值分别为 76%和 93%。
在 ETT 期间 aVR 导联的 ST 段抬高可能提示 LMCA 疾病的高概率存在。
