Circulation, Vol 65, 1465-1474, Copyright © 1982 by American Heart Association
P Guiteras, BR Chaitman, DD Waters, MG Bourassa, JM Scholl, RJ Ferguson and P Wagniart
The diagnostic accuracy of 14-lead exercise electrocardiography was
evaluated in 112 women who had no history of myocardial infarction and
underwent coronary angiography. The sensitivity of ST-segment displacement
of 0.1 mV or more in any of 14 ECG leads was 0.79 for coronary artery
stenosis of at least 70%; the specificity was 0.66. Results were similar
using bipolar ECG leads CC5 and CM5 or 11 standard ECG leads. The
ST-segment shifts that occurred only during exercise were associated with a
77% false-positive rate (10 of 13). Downsloping ST-segment depression did
not provide more diagnostic information than horizontal ST-segment
depression in the three clinical subsets of women. In women with typical
angina pectoris, ST-segment depression of at least 0.15 mV for 0.08 second
after the J point or a final treadmill time less than 360 seconds was
predictive of proximal left or multivessel coronary artery disease. In the
women with probable angina or nonspecific chest pain, this finding was not
of diagnostic value. ST- segment elevation of 0.1 mV or more in leads V1-2
or a VL predicted proximal stenosis of at lest 80% in the left anterior
descending coronary artery in all six women with typical angina pectoris.
Maximal exercise testing in women with typical angina provides important
diagnostic information when 11 standard ECG leads are recorded. In women
with probable angina or nonspecific chest pain, diagnostic exercise testing
is less useful and bipolar leads CC5 and CM5 are sufficient for most
clinical purposes.
ARTICLES
Diagnostic accuracy of exercise ECG lead systems in clinical subsets of women
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