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The Influence of R-Wave Amplitude on the Degree of ST-Segment Depression in Exercise Electrocardiography in the Individual Patient

Cardiology Department, Tzanio Hospital, Piraeus, Greece, Department of Hygiene and Statistics, University of Athens, Athens, Greece

Apostolos Papantonakos, M.D.

Cardiology Department, Tzanio Hospital, Piraeus, Greece, Department of Hygiene and Statistics, University of Athens, Athens, Greece

Costas Perrakis, M.D.

Cardiology Department, Tzanio Hospital, Piraeus, Greece, Department of Hygiene and Statistics, University of Athens, Athens, Greece

Spyros Argyrakis, M.D.

Cardiology Department, Tzanio Hospital, Piraeus, Greece, Department of Hygiene and Statistics, University of Athens, Athens, Greece

George Kouvaras, M.D., F.I.C.A.

Cardiology Department, Tzanio Hospital, Piraeus, Greece, Department of Hygiene and Statistics, University of Athens, Athens, Greece

Anastasia Tzonou, M.D.

Cardiology Department, Tzanio Hospital, Piraeus, Greece, Department of Hygiene and Statistics, University of Athens, Athens, Greece

Kyriakos Patsouros, M.D.

Cardiology Department, Tzanio Hospital, Piraeus, Greece, Department of Hygiene and Statistics, University of Athens, Athens, Greece

Many factors have been found to influence the magnitude of ST-segment depression in the exercise electrocardiogram. We investigated whether R-wave amplitude is a significant factor. We studied the exercise electrocardiogram of 20 patients with angiographically documented coronary artery disease, including 70% stenosis of the left anterior descending artery, who had an ischemic response to exercise but no previous anterior myocardial infarction. Precordial leads V_1-6 were taken into account.

When all 120 leads were measured, those with ST-segment depression 2.0mm at peak exercise had a mean resting R-wave amplitude of 19.03±5.81mm; those with ST-segment depression 2.0-1.0mm, R 11.42±5.99mm; and those with ST-segment depression < 1.0mm, R 5.9±5.21mm (p < 0.001 between groups). When the R-wave amplitude was correlated with the ST-segment depression in each precordial lead, the correlation was 1.0. In leads V_1-6, when 67 tracings with ST-segment depression > 0.5mm were measured, the correlation was 0.537 (p < 0.001). In each precordial lead the t values of R-wave differences correlated very strongly (r < 0.883) with the differences in ST-segment depression. We conclude that precordial R-wave amplitude significantly influences the magnitude of ST-segment depression.

Angiology, Vol. 38, No. 1, 22-27 (1987)
DOI: 10.1177/000331978703800103


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