Studies on ergometer exercise testing II. Effect of previous myocardial infarction, digoxin, and β‐blockade on exercise electrocardiography

Pellinen, Timo J.; Virtanen, Kari; Valle, M; Frick, M. H.

doi:10.1002/clc.4960091006

Cited by 10 publications

(5 citation statements)

References 40 publications

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“…Additionally, no patient in this group was taking concomitant digoxin, a medication that has been implicated causally in both exercise-induced ST depression 1 6,17 and elevation. 18 Likewise, the one patient with no prior MI, no detectable inducible ischemia, and no LVH had none of the commonly accepted mechanisms for ST elevation. However, in contrast to the 14 patients in this subgroup that did have LVH, this patient developed typical anginal discomfort during the test.…”

Section: Discussionmentioning

confidence: 95%

False Positive ST Segment Elevation During Dobutamine Stress Echocardiography Due to Left Ventricular Hypertrophy

2002

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The significance of ST segment elevation in dobutamine stress echocardiography (DSE) remains controversial. In patients with prior Q wave myocardial infarction (MI), it may reflect myocardial ischemia, contractile reserve in the infarct-related area, or dyskinesia of the infarcted areas of myocardium. In the nonpost-MI population, it has been attributed to vasospasm or strongly associated with coronary artery disease and ischemia. We hypothesized that ST segment elevation in the absence of inducible ischemia or prior MI is related to the presence of left ventricular hypertrophy (LVH). During DSE, dobutamine was infused from 5 microg/kg/min up to a maximum of 50 microg/kg/min. Echocardiographic images were obtained at baseline, low dose, peak dose, and recovery. Ischemia was defined as either the development of a new wall-motion abnormality or worsening wall motion at peak dose. We reviewed 682 consecutive DSE tests and found ST elevation in 42 patients (incidence = 6.1%). After excluding two patients for > 10% uninterpretable echocardiographic segments, the study population consisted of 40 patients. In 25 patients with ST elevation and without echocardiographic evidence for dobutamine-induced ischemia, 21 (84%) patients had LVH (P = 0.001). In 15 patients with inducible ischemia, only 4 (27%) patients had LVH. No other significant differences were found except that prior MI was more common in the inducible ischemia group. In the subgroup of 18 patients without prior MI, no inducible ischemia was found in 15 (83%). LVH was present in 14 (93%) of these 15 patients (P < 0.005), and all 14 had a normal baseline left ventricular ejection fraction. None of the three patients in the nonpost-MI subgroup with inducible ischemia had LVH. The 22 patients with prior MI had no significant association with LVH (P = 0.39). We conclude that ST segment elevation during DSE can occur without echocardiographic evidence for ischemia and is associated with LVH in the nonpost-MI population. This ST elevation may be related to transient electrocardiographic repolarization changes in the hypertrophied ventricle in the presence of altered loading conditions and/or altered catecholamine influences rather than true ischemia.

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Section: Discussionmentioning

confidence: 95%

False Positive ST Segment Elevation During Dobutamine Stress Echocardiography Due to Left Ventricular Hypertrophy

2002

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“…Although a recent study by Pellinen et al [21 ] showed that digitalis did not have any significant effect on the sensitivity and specificity of exer cise ECGs, it still remains controversial as to what extent digitalis alters the ECG with exercise. Our study included only 4 patients on digoxin at the time of the study.…”

Section: Discussionmentioning

confidence: 99%

Clinical Significance of Electrocardiographic T -Wave Normalization with Exercise

Wagoner¹,

Movahed²,

Reeves³

et al. 1993

Am J Noninvas Cardiol

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A change from inverted T waves at rest to an upright position with exercise, has been debated to be a sign of myocardial ischemia. Retrospective analysis has been performed on exercise thallium-201 myocardial scintigrams from 82 consecutive patients with T-wave inversion of at least 1 mm or more on their resting electrocardiogram (ECG) and normalization with exercise. Ischemia was indicated by a transient myocardial perfusion defect with exercise, and probable scar was indicated by a fixed myocardial defect. This gave four groups: (I) 30 patients had no defects; (II) 36 patients had fixed defects alone; (III) 2 patients had transient defects alone, and (IV) 15 patients had both fixed and transient myocardial perfusion defects. Sixty-six out of 83 (80%) studies with normalization demonstrated no transient myocardial perfusion defect. T-wave normalization occurred often in the leads corresponding to the area of fixed myocardial perfusion defect (77% in group II and 80% in group IV). In 33 patients with coronary angiography, correlation was similar with T-wave normalization found in the distribution of coronary artery disease in 77%. Compared to 251 consecutive patients undergoing exercise thallium testing for suspected coronary artery disease, the study group had a similar frequency of scans without defects, but relatively more studies with fixed relative to transient defects. We conclude that normalization is a nonspecific finding which may be associated with coronary artery disease and fixed myocardial perfusion defect. T-wave normalization with exercise has poor positive predictive value for the diagnosis of transient myocardial perfusion defect.

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“…The results indicate that the pathological changes of the coronary heart disease have a much greater effect on the exercise ECG variables than the drugs or arterial hypertension (cf. also Pellinen et al, 1986).…”

Section: Effects Of Medication and Arterial Hypertensionmentioning

confidence: 99%

Relationships between exercise ECG and angiocardiographic indices of coronary insufficiency and myocardial fibrosis in coronary heart disease

Backman

Jacobsson

Linderholm

et al. 1993

Clinical Physiology

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Patients with coronary heart disease were examined with exercise ECG and angiocardiography. Maximum work capacity expressed as a percentage of the predicted normal exercise tolerance (Wmax%) was significantly associated with the angiocardiographic score of the myocardial mass subserved by obstructed coronary arteries (MCOS). Variables related to myocardial fibrosis (MF) such as post infarction ECG signs, the left ventricular wall motion score (LVMS) and the ejection fraction of the left ventricle (LVEF) correlated significantly as did variables related to reversible myocardial ischaemia or coronary insufficiency (CI), such as ST depression during exercise (STdepr), ST/W and ST/HR indices, effort angina (EA/W) index, the extent of collaterals (CollS), and 'MCOS-LVMS'. MF variables correlated weakly with CI variables. Wmax% covariated with the variables related to both CI and MF, and most closely with MCOS. Discrepancies between results of exercise ECG and angiocardiography have to some extent been overcome by comparing appropriate parameters.

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Studies on ergometer exercise testing II. Effect of previous myocardial infarction, digoxin, and β‐blockade on exercise electrocardiography

Cited by 10 publications

References 40 publications

False Positive ST Segment Elevation During Dobutamine Stress Echocardiography Due to Left Ventricular Hypertrophy

False Positive ST Segment Elevation During Dobutamine Stress Echocardiography Due to Left Ventricular Hypertrophy

Clinical Significance of Electrocardiographic T -Wave Normalization with Exercise

Relationships between exercise ECG and angiocardiographic indices of coronary insufficiency and myocardial fibrosis in coronary heart disease

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