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European Heart Journal 1989 10(6):538-542;
Copyright © 1989 by the European Society of Cardiology.
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© 1989 The European Society of Cardiology

Contribution of cross-sectional echocardiography to the diagnosis of right ventricular dysplasia at the asymptomatic stage

R. SCOGNAMIGLIO, G. FASOLI, A. NAVA, G. MIRAGLIA*, G. THIENE and S. DALLA-VOLTA

Department of Cardiology Padua, Italy
*Pathology, Medical School, University of Padua Padua, Italy

Received 28 June 1988; accepted 5 December 1988.

Address for reprints: R.Scognamiglio MD, Cattedra di Cardiologia, Policlinico, via Giustiniani 2, 35100 Padova, Italia.

Abstract

The diagnostic accuracy of conventional exercise electrocardiography was compared with exercise algorithms specifically aimed at application in females, with R wave and heart rate adjusted ST-segment changes, and with discriminant analysis. A symptom-limited bicycle exercise test was performed by 189 females without previous infarction with a normal electrocardiogram (ECG) at rest. Frank lead ECG was computer processed. ST-segment amplitudes in lead X were superior to measurements in lead Y, but their sensitivity amounted only to 50% at a specificity of 90%. Correction for R wave amplitude marginally increased sensitivity. It was confirmed that leads with inferiorly directed vectors such as standard leads II, III, a VF or Frank lead Y should not be used for diagnostic purposes in females. Exercise-induced increases in R-wave amplitude of at least 01 mV occurred in only 8% of females with coronary disease. Previously described discriminant function using attained heart rate, ST-segment depression and a sex-dependent ST segment correction factor yielded a sensitivity of 60% at a specificity of 90%. Sensitivities of heart rate adjusted ST-segment changes and of a previously proposed discriminant function were greater than 70% at a specificity of 90%. It is concluded that the diagnostic yield of exercise testing in females can be improved by use of more sophisticated electrocardio-graphic and exercise variables.

Key Words: Diagnosis • coronary artery disease • coronary artery disease • exercise testing • females


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