Correlation of computer-quantitated treadmill exercise electrocardiogram with arteriographic location of coronary artery disease.

Abstract Graded treadmill exercise testing and coronary cinearteriographic studies were carried out on 86 patients with angina pectoris. At rest, all patients demonstrated a normal S-T segment on the modified bipolar lead V 5 recording used. The computer-quantitated S-T segment response to exercise was correlated with the location and extent of obstructive coronary artery disease. The coronary cineartertograms were reviewed by 3 physicians and stenosis of 75 percent or greater was considered significant. All patients showed at least this degree of stenosis in 1 or more major coronary arteries, and 83 of 86 exhibited 90 percent or greater stenosis in at least 1 artery. Thirty-one patients had stenosis in a single artery, 43 had stenosis in 2 arteries and 12 had significant lesions in all 3 major arteries. In 70 of the 86 (82 percent) patients, a positive S-T segment response developed during or immediately after exercise. In 12 of the 16 with a negative response, disease was limited to a single artery. In 11 of the 12 the disease was restricted to the right coronary or left circumflex arteries. Of the 12 patients with an isolated stenosis of the left anterior descending artery, 11 (92 percent) had a positive S-T segment response. Of 55 patients with 2- or 3-vessel disease, 51 (93 percent) demonstrated a positive S-T response. Graded treadmill exercise testing in 80 patients with chest pain, normal coronary art eriograms and normal left ventricular function revealed 4 (5 percent) with a false positive S-T segment response. The possible mechanisms underlying the high incidence of false negative exercise electrocardiographic tests in patients with disease isolated to the right coronary or left circumflex artery are discussed.