Post Exercise T Wave Changes in Patients with Normal and Abnormal Coronary Arteriogram

The pre- and postexercise ECGs of those with normal (n = 15) and those with abnormal (n = 66) coronary arteriogram (diameter reduction greater than or equal 50% regarded as significant) were compared in a series of 81 patients with effort angina. ECGs with other known causes of ST-T changes had been excluded. The ECGs 2 and 4 min after a bicycle exercise test were studied for an abnormal ST reaction, and the change in the T wave amplitude in lead V2 from before to 2 min after exercise was measured when there was no q wave, QS complex or negative T at rest in this lead. None of the 15 patients in the normal arteriogram group had abnormal ST reaction post exercise and 1 of 13 evaluable ECGs showed a reduction of T in V2 greater than or equal to 20%. In the abnormal arteriogram group, 37 of the 66 patients had an abnormal reaction and 17 of the remaining 26 evaluable ECGs showed a reduction of T in V2 greater than or equal to 20%. The sensitivity of an abnormal ST reaction for significant coronary obstructions was 56% at specificity of 100%. Addition of an alternative criterion of a reduction of the T amplitude in lead V2 greater than or equal to 20% from before to 2 min post exercise increased the sensitivity to 82% and decreased the specificity to 92%. Thus, it seems worthwhile to study the T V2 reaction in angina patients who do not show an abnormal ST reaction post exercise.