Exercise-induced ST-segment elevation in leads aVR and V1 for the prediction of left main disease

Background This study investigated the value of exercise-induced ST-segment elevation in lead aVR with or without concomitant ST-segment elevation in lead V1 for detection of left main (LM) coronary artery disease in patients with Duke treadmill score ≤− 11. Methods One hundred and four patients with Duke treadmill score ≤− 11 were retrospectively screened for presence of ST-segment elevation in lead aVR and lead V1. Results Twenty-six out of 65 patients with ST-segment elevation in lead aVR and 24 out 38 patients with ST-segment elevation in lead aVR with concomitant ST-segment elevation in lead V1 were found to have LM disease. Exercise-induced ST-segment elevation in lead aVR had a sensitivity of 92.9% and a specificity of 48.6% and ST-segment elevation in lead aVR accompanied by ST-segment elevation in lead V1 had a sensitivity of 85.7% and a specificity of 81.6% in predicting LM disease. Conclusions This study shows that the observation of exercise-induced ST-segment elevation in lead aVR is a sensitive, but not a specific, electrocardiographic finding of significant LM coronary artery disease. However, exercise-induced ST-segment elevation in lead aVR accompanied by ST-segment elevation in lead V1 might be not only a sensitive but also a specific finding of LM stenosis in these patients.