Exercise electrocardiogram in patients with normal and abnormal coronary arteriogram

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Abstract
The predictability of normal and significantly abnormal coronary arteriogram from history, symptoms during exercise test and post exercise ECG changes was examined in seventy patients with chest pain consistent with effort angina. The combined criteria (1) increasing chest pain until interruption of the exercise test plus (2a) appearance or increase of a biphasic T wave post exercise or (2b) a previous acute myocardial infarction, were found to have a sensitivity of 81 % and a specificity of 94%. Substituting ST depression for the T wave criterion did not increase either figure, nor did adding ST depression as an alternative criterion to the T wave biphasicity. As inspecting the T wave configuration is simpler than measuring the ST depression, T biphasicity seems to be an alternative to ST depression. The only factor found in all patients with abnormal coronary arteriogram was chest pain increasing continuously during the exercise test until its interruption. This pain pattern occurred only in 71% of patients with normal arteriogram, and thus the absence of this pain pattern may be used to avoid some normal coronary arteriographies.