Russo Giulio, Ravenna Salvatore Emanuele, De Vita Antonio, Aurigemma Cristina, Lamendola Priscilla, Lanza Gaetano Antonio, Crea Filippo
Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy.
Clin Cardiol. 2017 Feb;40(2):102-108. doi: 10.1002/clc.22637. Epub 2016 Nov 2.
The role of exercise stress test (EST)-induced ST-segment elevation (STE) in electrocardiographic lead aVR in predicting severe coronary artery disease (CAD) is controversial.
Assessment of lead aVR during EST can be helpful to identify patients with severe CAD.
We performed maximal EST in 200 patients undergoing coronary angiography for suspect of CAD. Four angiographic findings of severe CAD were considered: (1) left main (LM) disease; (2) LM or equivalent LM (LM/EQLM) disease; (3) LM or proximal left anterior descending (LAD) artery (LM/proxLAD) disease; and (4) LM or 3-vessel (LM/3V) disease.
LM, LM/EQLM, LM/proxLAD, and LM/3V disease were shown in 6 (3%), 13 (6.5%), 33 (16.5%), and 27 (13.5%) patients, respectively. EST-induced STE in aVR occurred in 41 patients (20.5%). ST-segment depression (STD) in ≥5 leads was the only predictor of LM stenosis (odds ratio [OR]: 6.18, 95% confidence interval [CI]: 1.19-32.2, P = 0.03) and the most significant variable associated with LM/proxLAD stenosis (OR: 4.73, 95% CI: 2.0-11.2, P = 0.0001); maximal STD ≥3 mm was the most significant variable associated with LM/EQLM (OR: 7.58, 95% CI: 2.31-24.9, P = 0.001) and LM/3V (OR: 3.86, 95% CI: 1.47-10.1, P = 0.006) CAD. EST-induced STE in aVR was associated with LM/proxLAD disease only (OR: 3.23, 95% CI: 1.44-7.24, P = 0.004). At multivariate analysis, STD in ≥5 leads was the only independent predictor of LM/proxLAD disease (OR: 3.99, 95% CI: 1.58-10.1, P = 0.003).
EST-induced STE in lead aVR does not significantly increase the prediction of severe CAD compared with severity and extension of STD as assessed in the other electrocardiographic leads.
运动负荷试验（EST）诱发的心电图aVR导联ST段抬高（STE）在预测严重冠状动脉疾病（CAD）中的作用存在争议。
EST期间对aVR导联的评估有助于识别严重CAD患者。
我们对200例因疑似CAD而接受冠状动脉造影的患者进行了最大负荷EST。严重CAD的四种血管造影表现被考虑：（1）左主干（LM）病变；（2）LM或等同LM（LM/EQLM）病变；（3）LM或左前降支近端（LAD）动脉（LM/proxLAD）病变；以及（4）LM或三支血管（LM/3V）病变。
分别有6例（3%）、13例（6.5%）、33例（16.5%）和27例（13.5%）患者出现LM、LM/EQLM、LM/proxLAD和LM/3V病变。41例患者（20.5%）出现EST诱发的aVR导联STE。≥5个导联的ST段压低（STD）是LM狭窄的唯一预测指标（比值比[OR]：6.18，95%置信区间[CI]：1.19 - 32.2，P = 0.03），也是与LM/proxLAD狭窄相关的最显著变量（OR：4.73，95% CI：2.0 - 11.2，P = 0.0001）；最大STD≥3 mm是与LM/EQLM（OR：7.58，95% CI：2.31 - 24.9，P = 0.001）和LM/3V（OR：3.86，95% CI：1.47 - 10.1，P = 0.006）CAD相关的最显著变量。EST诱发的aVR导联STE仅与LM/proxLAD病变相关（OR：3.23，95% CI：1.44 - 7.24，P = 0.004）。在多变量分析中，≥5个导联的STD是LM/proxLAD病变的唯一独立预测指标（OR：3.99，95% CI：1.58 - 10.1，P = 0.003）。
与其他心电图导联评估的STD严重程度和范围相比，EST诱发的aVR导联STE并不能显著提高对严重CAD的预测能力。
