Comparing the Efficacy of Electrocardiographic Leads in Recovery Phase in Detecting Coronary Artery Disease in Women

Different methods have been suggested to improve the limited diagnosing accuracy of exercise electrocardiography in detection of coronary artery disease (CAD) in women. To the best of our knowledge, the methods developed lack comprehensive comparison of a lead-by-lead basis. This study aimed to compare the diagnostic performance of ST segment depression and T wave alternans (TWA) at peak, 1 and 3 min of the recovery phase in leads I, aVL, V1 and V5. The study included 245 women participating in the Finnish Cardiovascular Study. Receiver operating characteristic curve (ROC) curve analysis was performed to evaluate the overall diagnostic performance. The areas under the ROC curve for ST segment depression at peak, 1 and 3 min of the recovery phase in leads I and V5 were more than 80%, while leads V1 and aVL achieved the smallest area. For TWA, the largest areas were obtained at 3 min of the recovery phase. At 80% of specificity, different cut-points were achieved for ST segment depression but the same cut-points for TWA at 1 and 3 min of the recovery phase. This study suggests that the limited diagnostic accuracy of ST segment depression to detect CAD can be improved by determining the appropriate lead and lead specific cut-point selection. TWA rather depends on determining the best time point of recovery phase for diagnosis of CAD in women.