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Michaelides A.P.,Exercise Laboratory and Catheterization Laboratory | Liakos C.I.,Exercise Laboratory and Catheterization Laboratory | Antoniades C.,Exercise Laboratory and Catheterization Laboratory | Dilaveris P.E.,Exercise Laboratory and Catheterization Laboratory | And 6 more authors.
Clinical Cardiology

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 V5 R 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, restenosiswas 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. © 2010 Wiley Periodicals, Inc. Source

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