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. 2010 Feb 16;33(4):236–240. doi: 10.1002/clc.20609

Right‐sided Chest Leads in Exercise Testing for Detection of Coronary Restenosis

Andreas P Michaelides 1,✉, Charalampos I Liakos 1, Charalambos Antoniades 1, Polychronis E Dilaveris 1, Eleftherios G Tsiamis 2, Konstantinos P Tsioufis 2, Konstantina D Aggeli 1, Konstantinos P Toutouzas 1, Leonidas G Raftopoulos 1, Christodoulos I Stefanadis 2
PMCID: PMC6653329  PMID: 20162735

Abstract

Background

The incorporation of right‐sided chest leads (V3R through V5R) into standard exercise testing has been reported to improve its diagnostic utility.

Hypothesis

The purpose of this study was to evaluate any improvement in the ability of exercise testing in detecting restenosis, using additional V3R through V5R leads, in asymptomatic patients undergoing percutaneous coronary intervention (PCI) in the right coronary artery (RCA) or/and left circumflex (LCX).

Methods

We studied 172 consecutive patients (54 ± 7 years old, 106 males) undergoing PCI in RCA or/and LCX. A treadmill test had been performed before PCI. Six months later, all patients underwent a second treadmill test and arteriography in order to detect silent ischemia due to restenosis. Recordings during exercise were obtained with the standard 12‐leads plus V3R through V5R.

Results

Out of 172 patients, 106 had stenosis in RCA, 35 in LCX, and 31 in both vessels while 6 months later, restenosis was detected in 8 (for RCA), 3 (for LCX), and 3 (for both vessels) patients respectively. Sensitivity, specificity, positive prognostic value, negative prognostic value, and accuracy of exercise testing performed post PCI were ameliorated using V3R through V5R (79% vs 57%, 97% vs 80%, 69% vs 21%, 98% vs 95%, and 95% vs 78% respectively, P < .05 for all except negative prognostic value). Maximal exercise‐induced ST‐segment deviation (in mm) was not changed post PCI in 12 leads (1.4 ± 0.2 vs 1.5 ± 0.2, P = NS) while it was decreased in V3R through V5R (0.2 ± 0.2 vs 1.2 ± 0.3, P < .01).

Conclusions

The addition of V3R through V5R improves the diagnostic ability of standard exercise testing in detecting silent ischemia due to restenosis in patients undergoing PCI in RCA or/and LCX. Copyright © 2010 Wiley Periodicals, Inc.

Full Text

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