Spontaneous Normalization of Negative T Waves in Infarct-Related Leads Reflects Improvement in Left Ventricular Wall Motion even in Patients with Persistent Abnormal Q Waves after Anterior Wall Acute Myocardial Infarction

Nagase, Kimiaki; Tamura, Akira; Mikuriya, Yoshiaki; Nasu, Masaru

doi:10.1159/000049090

Cited by 6 publications

(2 citation statements)

References 27 publications

(24 reference statements)

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“…24 We did not evaluate the time course of changes in the T-wave. However, some patients (23) without an increase in R-waves showed improvement in LVEF, which may accord with the results of the previous study.…”

Section: Discussionmentioning

confidence: 99%

Increase in Electrocardiographic R-Waves After Revascularization in Patients With Acute Myocardial Infarction

Isobe

Takada

Ando

et al. 2006

Circ J

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spontaneous increase in the electrocardiographic (ECG) R-wave voltage after acute myocardial infarction (MI) is a unique phenomenon, and regeneration of R-waves or disappearance of Q-waves after acute ischemic events has been reported. [1][2][3][4][5][6][7] With the prevalence of interventional therapy, it is thought that this phenomenon is increasing, but little is known regarding the physiological mechanism involved.Patients with acute MI always undergo echocardiography in order to evaluate changes in wall motion, left ventricular (LV) cavity, and LV function over time. Myocardial scintigraphy provides important information about myocardial perfusion and/or metabolism. Specifically, a combined study of myocardial metabolic tracer with perfusion tracer provides clues about the myocardial status in the healing stage of MI. [8][9][10] Perfusion -metabolism mismatch of the Circulation Journal Vol. 70, November 2006 perfusion/metabolic dual-tracers represents impaired but viable myocardium in the risk area, which is involved in functional recovery after revascularization in patients with acute MI. 11-13 Therefore, both examinations are cardinal diagnostic modalities for patients after acute MI.In this study, we performed dual-isotope scintigraphy and echocardiography, and compared the findings with ECG results to determine the physiological mechanism of the increase in ECG R-wave voltage during the acute to the subacute phase after revascularization in patients with acute MI. Methods PopulationOne hundred and seventy-one consecutive patients with first onset of acute MI who underwent emergency coronary revascularization, dual-isotope scintigraphy, and echocardiography between January 1998 and March 2004 were retrospectively examined. Acute MI was diagnosed by typical chest pain for >30 min, ECG ST-elevation of ≥0.1 mV (1 mm) in at least 2 contiguous leads, and a characteristic rise in plasma creatine kinase-MB activity. All patients underwent emergency coronary angiography (CAG) immediately after the ECG diagnosis and subsequent coronary revascularization. In the emergency CAG, antegrade flow was characterized using the Thrombolysis In Myocardial Background The physiological mechanism of the increase in the electrocardiographic (ECG) R-wave voltage after revascularization in patients with acute myocardial infarction (MI) needs to be elucidated. Methods and ResultsOne hundred and thirty-eight MI patients (83: anterior MI, 45: inferior MI, 10: lateral MI) underwent ECG and echocardiography in both the acute and subacute phases after emergency revascularization, as well as a resting thallium-201/iodine-123 15-p-iodophenyl-3-(R,S)-methyl pentadecanoic acid myocardial scintigraphy in the acute phase. The total sum of the R-wave voltage (∑R) was calculated over multiple leads on ECG for each infarcted lesion. Scintigraphic defect on each tracer was expressed as the percentage (%) defect of the total left ventricular (LV) myocardium. The % defect-discordance on both images in the acute phase and the % increase in ∑R an...

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Section: Discussionmentioning

confidence: 99%

Increase in Electrocardiographic R-Waves After Revascularization in Patients With Acute Myocardial Infarction

Isobe

Takada

Ando

et al. 2006

Circ J

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“…Several reports suggest that normalization of T-waves either spontaneously over time 5,6 or during stress 7 -11 in leads demonstrating prior infarction is indicative of ischemic but viable myocardium in the peri-infarction region. Elhendy and associates 12 studied 36 patients with non-Q-wave infarction and abnormal T-waves at rest.…”

Section: Discussionmentioning

confidence: 99%

Normalization of Abnormal T‐waves During Stress Testing does not Identify Patients with Reversible Perfusion Defects

Loeb

Friedman

2007

Clinical Cardiology

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SummaryObjective: To determine if T-wave normalization during exercise or dobutamine stress testing identified patients with myocardial ischemia as indicated by reversible perfusion defects.Methods: Exercise or dobutamine stress tests with perfusion scintigraphy were performed in 1,173 patients with abnormal T-waves on their baseline electrocardiograms. The results of perfusion scintigraphy were compared in patients with and without stress-induced T-wave normalization.Results: Only 33 of 270 patients with reversible perfusion defects (12.2%) had T-wave normalization during stress while 76.4% of 140 patients who had T-wave normalization during stress did not have a reversible perfusion defect. Results were similar for patients who did or did not reach 85% of their maximal predicted heart rate, for patients with and without Q-wave infarction on the baseline EKG and for patients who did or did not have ischemic ST-segment depression during stress.Conclusions: T-wave normalization during stress testing has low sensitivity and poor positive predictive value for stress-induced reversible myocardial ischemia.

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Electrocardiographic Background

and¹,

Schweitzer²

2004

Dynamic Electrocardiography

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Spontaneous Normalization of Negative T Waves in Infarct-Related Leads Reflects Improvement in Left Ventricular Wall Motion even in Patients with Persistent Abnormal Q Waves after Anterior Wall Acute Myocardial Infarction

Cited by 6 publications

References 27 publications

Increase in Electrocardiographic R-Waves After Revascularization in Patients With Acute Myocardial Infarction

Increase in Electrocardiographic R-Waves After Revascularization in Patients With Acute Myocardial Infarction

Normalization of Abnormal T‐waves During Stress Testing does not Identify Patients with Reversible Perfusion Defects

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