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European Heart Journal 1988 9(4):412-417;
Copyright © 1988 by the European Society of Cardiology.
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© 1988 The European Society of Cardiology

The relationship between ST segment deviation projected to the front of the chest during exercise and simultaneous Holter monitoring

K. EGSTRUP

Department of Cardiology, Odense University Hospital DK-5000 Odense C, Denmark

Received 29 December 1986; revised 9 October 1987; .

Address for reprints: Kenneth Egstrup, M.D., Department of Cardiology, Odense University Hospital, DK-5000 Odense C, Denmark

Abstract

Simultaneous two-channel Holter monitoring, with a direct recording system, and maximal exercise testing with a 12-lead precordial electrocardiographic mapping system were performed in 50 patients with chest pain (41 with documented coronary artery disease, 9 without). The exploring Holter leads were placed to correspond to CM5 and an aVF-like lead. In 36 patients, ST segment changes were found with both Holter and the 12-lead precordial electrocardiogram, while in 12 patients no ischaemic changes were detected by either method. Thus the results of the two methods concurred in 48 of 50 patient (96%). The magnitude of the ischaemic change was similar in 24 of 36 patients (67%), while the Holter system underestimated the ischaemic change by 0.5–2.0 mm in 12 patients. When the maximal ST segment deviation in V5 was compared with CM5, the deviations with both systems were identical in all but one patient in whom a difference of 0.5 mm was found. The use of a Holter lead resembling aVF identified maximal ST segment change on only one occasion, and in only four patients was an ST segment change of 1 mm noted.

In conclusion, ambulatory monitoring utilizing only CM5 seems to detect most episodes with ST segment changes, but the use of a 12-lead precordial mapping system during exercise testing may expand the possibility of defining the optimal sites for the exploring Holter leads to detect maximal ST segment change.

Key Words: Ambulatory electrocardiographic monitoring • direct recording • exercise electrocardiography • precordial electrocardiographic mapping • coronary artery disease


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