Ability of the R--Wave Change During Stress Testing to Accurately Detect Coronary Disease in the Presence of Left Bundle Branch Block at Rest

Greenberg, Paul S.; Ellestad, M. H.
April 1980
Angiology;Apr1980, Vol. 31 Issue 4, p230
Academic Journal
The treadmill stress test and angiographic records of 18 patients with left bundle block on resting ECG were reviewed retrospectively. Thirteen of the patients had significant coronary artery disease defined as ≥70% cross-sectional narrowing of one or more vessels, while 5 patients were hemodynamically and angiographically normal. The R-wave and ST-segment response to exercise were determined in each case and compared. A positive R-wave response was an exercise-induced increase or no change in amplitude over the baseline level, while a positive ST-segment response was ≥2 mm of exercise-induced depression over the baseline level. The sensitivity for the R-wave response was 69% (9 of 13), the specificity was 100% (5 of 5), and the predictive value was 100% (9 of 9). For ST depression these values were 46% (6 of 13), 40% (2 of 5), and 67% (6 of 9). Although the number of patients in this study is small a reflection of the fact that ST depression in the presence of left bundle branch block with exercise is associated with many false positive responses and hence less referral for stress testing it appears that the R-wave response to exercise in the presence of left bundle branch block can accurately detect coronary artery disease.


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