Electrocardiographic criteria for detecting coronary artery disease in hypertensive patients with ST-segment changes during exercise testing

Purpose

It is well known that patients with arterial hypertension frequently present with ischemic electrocardiographic changes during exercise testing without actually having coronary artery disease (CAD). The purpose of this study was to establish additional electrocardiographic criteria during exercise testing for detecting CAD in hypertensive patients with ischemic ST-segment response.

Methods

Three hundred eighty-two consecutive hypertensive patients (224 males, 58 ± 8 years) who presented with ischemic electrocardiographic changes during exercise testing and agreed to undergo coronary arteriography were included in the study.

Results

From 382 hypertensive patients undergoing coronary angiography, only 76 (20%) had significant coronary stenosis, whereas 306 (80%) had normal coronary arteries. From 382 patients, 287 (75%) (group A) presented with ST-segment depression during exercise in leads II-III-aVF-V₆, 271 (94%) of which had normal arteries at the angiography. The remaining 95 patients (25%) (group B) of the studied patients presented with ST-segment depression in II-III-aVF and/or V₄ through V₆, 60 (63%) of which had CAD. Furthermore, 251 patients of group A presented with ST-segment depression during the fourth to sixth minute of the recovery period in V₄ through V₆, 247 (98%) of which had normal arteries. Another 28 patients from group B presented with ST-segment depression during the fourth to eighth minute of the recovery period in V₄ through V₆, 22 (79%) of which had significant coronary artery stenosis.

Conclusions

Hypertensive patients who present with ST-segment depression during exercise in leads II-III-aVF and/or V₄ through V₆ and with a prolonged duration of this depression at the recovery phase (fourth to eighth minute) are more likely to have CAD. Absence of ST-segment depression in V₄ and V₅ at the end of exercise or during the seventh and eighth minute of recovery favors a false-positive result.