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September 25, 1954


JAMA. 1954;156(4):447. doi:10.1001/jama.1954.02950040153021

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To the Editor:—  In the article "Negative Master Tests in the Prodromal Stage of Myocardial Infarction" by J. Richard Durham of Wilmington, Del. (The Journal, June 26, 1954, page 826), there are several points on which I wish to comment.In the first place, the title of the paper, "Negative Master Tests," is not correct. Actually, the "two-step" illustrative electrocardiogram is not negative; it is positive, that is, abnormal, since the RS-T segment in precordial lead V4 is at least 1 mm. below the isoelectric level (P-R interval). The criterion for a positive "two-step" test is an RS-T segment depression of more than 0.5 mm. Hence, the major premise of the paper is false, and the conclusion is necessarily wrong. Furthermore, Dr. Durham does not state whether the single or double "two-step" test was used. This is extremely important, for, if the preliminary single "two-step" test is negative, the

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