Comparison of Patients With Anterior Wall Healed Myocardial Infarction With and Without Exercise-Induced ST-Segment Elevation

Candell‐Riera, Jaume; Santana-Boado, César; Armadans-Gil, Lluı́s; Blanch, Pedro; Aguadé, S; Castell, Joan Martí i; Vaqué‐Rafart, Josep; Soler‐Soler, Jordi

doi:10.1016/s0002-9149(97)00803-5

Cited by 12 publications

(8 citation statements)

References 16 publications

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“…Moreover, the presence and amount of viability depends on many factors, including ischemia and left ventricular function [6]. In fact, only limited data are available on global evaluation including myocardial viability, ischemia and left ventricular function in patients with ischemic cardiomyopathy and stress‐induced ST‐elevation [19,32]. In our study, exercise‐induced ST‐elevation had poor sensitivity, specificity and diagnostic accuracy for the prediction of viability in patients with ischemic cardiomyopathy.…”

Section: Discussionmentioning

confidence: 61%

“…According to previous studies [19–21], exercise‐induced ST‐segment elevation was defined as new or additional elevation >1 mm above the baseline segment level (80 m after the J point) on at least two electrocardiographic leads showing abnormal Q wave. The PQ segment was regarded as the isoelectric line.…”

Section: Methodsmentioning

confidence: 99%

“…However, these data are still controversial. Candell‐Riera and colleagues [19] recently reported an association between exercise‐induced ST‐elevation and both ischemia and left ventricular aneurysm. The aim of this study was to assess the respective roles of myocardial ischemia, residual viability and left ventricular function in the genesis of exercise‐induced ST‐elevation in patients with healed myocardial infarction.…”

Section: Introductionmentioning

confidence: 99%

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Exercise‐induced ST‐elevation is related to left ventricular dysfunction but not to myocardial viability in patients with healed myocardial infarction

Manrique¹,

Köning

Hitzel³

et al. 2001

European J of Heart Fail

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Background: Exercise-induced ST-segment elevation was proposed as a marker of myocardial viability after a recent myocardial infarction. Aims: The aim of this study was to evaluate whether exercise-induced ST segment elevation is related to viability or to left ventricular dysfunction in patients with history of old Q wave myocardial infarction. Methods: Fifty Ž . patients 43 men, age 57 " 11 years were studied 31 " 49 months after a Q wave myocardial infarction. They all underwent stress, reinjection-redistribution, and late redistribution Tl-201 SPECT, completed by equilibrium radionuclide angiography.Ž . Viability was defined by defect reversibility or significant ) 60% persistent Tl-201 uptake in dyssinergic segments on late redistribution SPECT. Relative post-exercise and reinjection-redistribution LV volumes were calculated using validated Ž . Ž . Ž software QGS . Results: Twenty-one out of 50 patients 42%, G1 had significant stress-induced ST-elevation ) 1 mm 80 ms . Ž . Ž . after J point in at least 2 ECG leads with Q wave , and 29r50 58%, G2 did not. Seventeen out of 50 patients 34% demonstrated myocardial viability on late redistribution scan. The diagnostic accuracy of exercise-induced ST-elevation was only 52% for viability assessment. Significant LVEF reduction and increased relative LV volumes were observed in G1 Ž compared to G2 LVEF: 39 " 10% vs. 49 " 11%, Ps 0.003; post-stress LV volume: 134 " 98 ml vs. 81 " 41 ml, P-0.02;. reinjection-redistribution LV volume: 123 " 86 ml vs. 79 " 40 ml; P-0.02 . Perfusion defects were similar in G1 and G2 Žpost-exercise: 38 " 12% vs. 37 " 14%, ns; reinjection-redistribution: 31 " 11% vs. 30 " 11%, ns; late redistribution: 30 " 10% . vs. 28 " 11%, ns . Conclusion: These results suggest that, in patients with history of myocardial infarction, exercise-induced ST-segment elevation is not related to persistent myocardial viability but is associated to left ventricular dysfunction. ᮊ

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Section: Discussionmentioning

confidence: 61%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Exercise‐induced ST‐elevation is related to left ventricular dysfunction but not to myocardial viability in patients with healed myocardial infarction

Manrique¹,

Köning

Hitzel³

et al. 2001

European J of Heart Fail

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“…Paradoxically, the information gleaned from these imaging methods has not clarified the interpretation of this ECG phenomenon, but has instead generated more confusion. Some investigators conclude that EISTE in Q wave leads is a highly specific marker of residual myocardial viability [1, 2, 3, 4, 5, 6, 7, 8], while others report strong evidence to the contrary [9, 10, 11, 12, 13, 14, 15](table 1). Such apparently discordant and mutually exclusive data are difficult to explain solely on the basis of differences in patient populations or methods.…”

Section: Introductionmentioning

confidence: 99%

Exercise-Induced ST Segment Elevation in Q Wave Leads in Postinfarction Patients: Defining Its Meaning and Utility in Today’s Practice

Gussak

Wright²,

Kopecky

et al. 2000

Cardiology

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Most attempts to identify qualitative and quantitative techniques for assessing myocardial viability and the likelihood of improved function after revascularization in patients with healed myocardial infarcts have focused on treatment strategies and prognosis. This review examines the true value of the electrocardiographic phenomenon of exercise-induced ST segment elevation (EISTE) in Q wave leads as a diagnostic tool for the assessment of myocardial viability. The prognostic potential and clinical utility of the EISTE phenomenon are inhibited both by the heart’s electrophysiologic response to exercise-induced metabolic and hemodynamic changes, and by the ECG’s limited facility in assessing myocardial preservation. The use of EISTE as an independent indicator for surgical intervention is proscribed by these limitations. The EISTE phenomenon could serve as a useful tool in the first line of discrimination in patients with healed Q wave myocardial infarction, and may justify further diagnostic work-up in patients under consideration for a revascularization procedure. In the era of sophisticated nuclear and echo techniques, accurate imaging studies should not be replaced by ECG analysis alone in the search for viable tissue, except when financial costs are of major importance.

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“…It has been interpreted as a sign of myocardial ischemia, 1,2 left ventricular wall motion abnormality (WMA) 3,4 or both, 5,6 and recent studies have suggested that ST-segment elevation during stress reflects myocardial viability. [7][8][9][10][11] Stress echocardiography has been proposed as a useful technique for the assessment of myocardial ischemia, left ventricular dysfunction and myocardial viability, but although exercise and pharmacological stress, such as dobutamine and dipyridamole, are widely used in stress echocardiography, there has not been a comparative study of the significance of the stressinduced ST-segment elevation of exercise, dobutamine and dipyridamole in identical patients.…”

mentioning

confidence: 99%

Stress-Induced ST-Segment Elevation Following Myocardial Infarction and Its Role in Wall Motion Abnormality, Myocardial Ischemia and Viability. Comparison of Response to Exercise, Dobutamine and Dipyridamole.

et al. 2001

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tress-induced ST-segment elevation is a common finding in patients after myocardial infarction (MI), but its mechanism is still controversial. It has been interpreted as a sign of myocardial ischemia, 1,2 left ventricular wall motion abnormality (WMA) 3,4 or both, 5,6 and recent studies have suggested that ST-segment elevation during stress reflects myocardial viability. [7][8][9][10][11] Stress echocardiography has been proposed as a useful technique for the assessment of myocardial ischemia, left ventricular dysfunction and myocardial viability, but although exercise and pharmacological stress, such as dobutamine and dipyridamole, are widely used in stress echocardiography, there has not been a comparative study of the significance of the stressinduced ST-segment elevation of exercise, dobutamine and dipyridamole in identical patients. Dobutamine and dipyridamole differ in their mechanism of inducing myocardial ischemia: dobutamine is a -receptor agonist that increases myocardial oxygen consumption, whereas dipyridamole causes vasodilation and induces vertical and horizontal blood steals. 12 The purpose of the present study was to determine the relationship between ST-segment elevation Japanese Circulation Journal Vol. 65, December 2001 and wall motion response during exercise, dobutamine and dipyridamole stresses, and to examine the mechanism of stress-induced ST-segment elevation following MI. MethodsTwenty-five consecutive patients, 24 men and 1 woman, aged 53±10 years, were prospectively enrolled. The criteria for recruitment were (1) admission to hospital with a diagnosis of first anterior acute MI and (2) abnormal Q wave in at least 2 leads on the electrocardiogram (ECG) performed in conjunction with stress echocardiography. Patients with bundle branch block (n=2), left ventricular hypertrophy (n=2), unstable angina (n=1), left ventricular failure (n=1), bronchial asthma (n=1), and those unable to exercise adequately (n=3) were excluded. One patient developed serious ventricular arrhythmia during a low dose dobutamine test (10 g·kg -1 ·min -1 ) was also excluded. Sixteen patients were treated with thrombolytic agents within 24 h from the beginning of symptoms and 5 patients underwent coronary angioplasty within 48 h from the onset of MI. None of the patients had a coronary stent implanted. Each patient underwent, in random order, exercise, dobutamine and dipyridamole echocardiography on different days and under the same medication. All stress tests were performed 4-6 weeks after the onset of MI. All antianginal drugs, such as -adrenergic blocking agents, nitrates and calcium antagonists, were discontinued on the day before the stress Stress-induced ST-segment elevation following myocardial infarction (MI) has been correlated with myocardial ischemia, viability and wall motion abnormality, but its mechanism is still unclear, so the present study compared ST-segment elevation and wall motion response during exercise, dobutamine and dipyridamole stresses. Twentyfive patients with their first anterior MI ...

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Comparison of Patients With Anterior Wall Healed Myocardial Infarction With and Without Exercise-Induced ST-Segment Elevation

Cited by 12 publications

References 16 publications

Exercise‐induced ST‐elevation is related to left ventricular dysfunction but not to myocardial viability in patients with healed myocardial infarction

Exercise‐induced ST‐elevation is related to left ventricular dysfunction but not to myocardial viability in patients with healed myocardial infarction

Exercise-Induced ST Segment Elevation in Q Wave Leads in Postinfarction Patients: Defining Its Meaning and Utility in Today’s Practice

Stress-Induced ST-Segment Elevation Following Myocardial Infarction and Its Role in Wall Motion Abnormality, Myocardial Ischemia and Viability. Comparison of Response to Exercise, Dobutamine and Dipyridamole.

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