Exercise and pharmacologic stress-induced interlead T-wave heterogeneity analysis to detect clinically significant coronary artery stenosis

•T-wave heterogeneity (TWH) is a novel measure of interlead splay of ECG waveforms.•TWH detects flow-limiting stenoses during ETT (AUC, 0.737, p < 0.0001) and MPI (AUC, 0.818, p < 0.0001).•ST-segment changes during ETT (p = 0.12) and MPI (p = 0.60) did not detect CAD.•Combining TWH with MPI improves specificity (to 95%), odds ratio (to 36.54), and positive likelihood ratio (to 13.16).•TWH testing is performed using standard protocols, equipment, and electrodes.