Significance of exercise-induced simultaneous ST-segment changes in lead aVR and V-5

This study was undertaken to investigate the ability of the exercise-induce d ST depression in lead V-5 and concomitant ST elevation in lead aVR for th e identification of the significantly narrowed coronary artery in patients with single vessel disease. We studied 229 consecutive patients who develop ed the aforementioned exercise-induced electrocardiographic changes. All un derwent Thallium-201 scintigraphy and coronary arteriography. Patients were divided into three groups. In group A, 58 patients with ST depression in V -5 and ST elevation in aVR, in group B 149 patients with ST depression in V -5 without ST elevation in aVR, and in group C 22 patients with ST elevatio n in aVR without ST depression in V-5 induced with exercise, were included. In group A, 81% of the patients while in group B, 29% and in group C only 18% of the patients had left anterior descending artery disease. According to Thallium-201 scintigraphy, 80% of the group A, 27% of the group B and 12 % of the group C patients developed myocardial ischemia in areas supplied b y the left anterior descending artery. Thus, exercise-induced ST depression in V-5 and concomitant ST elevation in aVR, may detect left anterior desce nding artery significant stenosis in patients with single vessel disease. ( C) 1999 Elsevier Science Ireland Ltd. All rights reserved.