Exercise‐induced ST‐segment Elevation in Leads V1 or aVL: A Predictor of Anterior Myocardial Ischemia and Left Anterior Descending Coronary Artery Disease

Exercise-induced ST-segment elevation in leads V1 and/or aVL in the absence of anterior Q waves occurred in 46 of 190 patients (24%) who underwent 12-lead exercise electrocardiography with thallium-201 myocardial perfusion imaging and coronary arteriography. Significant left anterior descending coronary artery (LAD) disease was present in 38 of 46 patients (83%) with V1/aVL ST elevation and in 72 of 144 patients (50%) without V1/aVL ST elevation (p < 0.0005). Anterior myocardial ischemia, indicated by reversible anterior perfusion defects on thallium scanning, was present in 40 of 46 patients (87%) with V1/aVL ST elevation and in 25 of 144 patients (17%) without V1/aVL ST elevation (p < 0.0005). Exercise ST elevation in V1/aVL was detected in 38 of 110 of the patients (35%) with LAD disease, for a specificity of 90%, and in 40 of 65 of the patients (62%) with anterior myocardial ischemia, for a specificity of 95%.We conclude that during 12-lead exercise electrocardiography, ST-segment elevation in V1 and/or aVL in the absence of anterior Q waves predicts anterior myocardial ischemia and LAD disease.

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