T wave normalization in infarct-related electrocardiographic leads during exercise testing for detection of residual viability

Mobilia, G; Zanco, Pierluigi; Desideri, Alessandro; Neri, G; Alitto, F; Suzzi, G; Chierichetti, Franca; Celegon, Leopoldo; Ferlin, G; Buchberger, R

doi:10.1016/s0735-1097(98)00205-8

Cited by 27 publications

(10 citation statements)

References 24 publications

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“…Several methods have been successfully used to detect viable myocardium and persistent myocardial ischemia in the peri-infarction zone including angiographic, scintigraphic and echocardiographic techniques. Recently, it has been shown that exercise-induced ST segment elevation and T wave normalization predict viable myocardium in the infarct region with good accuracy [4, 5, 6, 7, 8]. Scintigraphic and echocardiographic techniques are widely used to detect myocardial viability and ischemia, and have become standard techniques for the evaluation of viability and ischemia in patients with wall motion abnormalities after MI.…”

Section: Discussionmentioning

confidence: 99%

“…Normalization of negative T waves (TWN) on IRLs during exercise tests or dobutamine stress tests in patients with previous MI has recently been shown to represent the presence of ischemic but viable myocardium within the infarct area [4, 5, 6, 7, 8]. Identification of residual viability of areas of the myocardium that could be saved by a revascularization procedure is very important information for the cardiologist.…”

Section: Introductionmentioning

confidence: 99%

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Normalization of Negative T Waves in the Chronic Stage of Q Wave Anterior Myocardial Infarction as a Predictor of Myocardial Viability

Altun

Durmuş-Altun²,

Birsin³

et al. 2005

Cardiology

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We investigated whether spontaneous normalization of negative T waves (TWN) on infarct-related ECG leads (IRLs) in the chronic phase of Q wave anterior myocardial infarction (MI) could be a predictor of residual viability in infarct areas. We prospectively studied 35 patients (age 60 ± 8.6 years) in the chronic phase of Q wave anterior MI. Spontaneous TWN (group A, n = 23) were defined as negative T waves that became upright (≧0.15 mV) in ≧2 IRLs. The presence of negative T waves (group B, n = 12) was defined as symmetric or biphasic negative T wave of ≧0.15 mV. All patients underwent same-day rest ²⁰¹Tl-stress ^99mTc sestamibi dual-isotope myocardial perfusion SPECT and 24-hour ²⁰¹Tl reinjection imaging for ischemia and viability analysis. On scintigraphic examination, ischemic or viable myocardial segments were found in 18 patients (78%) with TWN and 4 patients (33%) of group B (p = 0.013). The use of TWN as a parameter had a marked influence on the sensitivity (82%), specificity (62%), positive (78%) and negative (67%) predictive values and accuracy (74%) of the diagnosis of viable myocardium. If we add the criterion of positive T waves in aVR with negative T waves to our criteria, we found that sensitivity (90%), positive (80%) and negative (80%) predictive values and accuracy (80%) increased. The results of our study suggest that analysis of TWN on IRLs is an accurate marker of residual viability and/or persistent peri-infarct ischemia in patients in the chronic stage of Q wave anterior MI, and therefore optimizes the diagnostic and therapeutic strategies after MI.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Normalization of Negative T Waves in the Chronic Stage of Q Wave Anterior Myocardial Infarction as a Predictor of Myocardial Viability

Altun

Durmuş-Altun²,

Birsin³

et al. 2005

Cardiology

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“…In the GISSI-3 (third Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico) echo substudy, the number of negative T waves decreased at six months in the majority of patients and this was associated with substantial recovery of regional dysfunction. 9 T wave normalisation induced by exercise testing predicts myocardial viability 8 and is often associated with late spontaneous T wave normalisation on the resting ECG. 13 In the chronic phase of infarction, patients with restored positive T waves who benefited from optimal revascularisation of the infarct related artery have better contractile reserve, shown with low dose dobutamine stress echocardiography, than those with negative T waves.…”

Section: T Wave Evolution and Left Ventricular Functionmentioning

confidence: 99%

Determinants of persistent negative T waves and early versus late T wave normalisation after acute myocardial infarction

Piérard

Lancellotti

2005

Heart

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Objective: To determine whether persistent versus early or delayed T wave normalisation of negative T waves after acute myocardial infarction is determined by the myocardial state, the treatment strategy, or both. Design: 127 consecutive patients with a first acute myocardial infarction and > 2 negative T waves on the 24-36 hour ECG were studied. They underwent dobutamine stress echocardiography and coronary angiography during the first week. ECG was recorded at hospital discharge and at a mean (SD) of 4 (1) months. Setting: University hospital. Results: T wave normalisation was observed in 88 patients (early at discharge in 19 and delayed at four months in 69). Early T wave normalisation was associated with sustained contractile reserve during dobutamine stress (13 of 19 (68%)), whereas delayed T wave normalisation was observed mainly in patients with an ischaemic response (49 of 69 (71%)). The persistence of negative T waves was associated with an ischaemic response (21 of 39 (54%)) or persistent akinesis (17 of 39 (44%)). Among patients with an ischaemic response to dobutamine, in-hospital elective angioplasty was an independent determinant of delayed T wave normalisation (39 of 49 v 4 of 21 patients with persistent negative T waves at four months, p , 0.0001). Conclusions: Early T wave normalisation is associated with dobutamine induced, sustained improvement indicating myocardial stunning. Delayed normalisation is observed mainly in patients with ischaemic myocardium who have undergone revascularisation. Persistent negative T waves correspond to either extensive necrosis or non-revascularised, jeopardised myocardium.T he clinical significance of negative T waves after acute myocardial infarction is controversial. Negative T waves early after thrombolysis are associated with patency of the infarct related artery, mild to moderate residual stenosis, and preserved left ventricular function [1][2][3] and are an independent predictor of one month survival. 4 In contrast, negative T waves were a predictor of death in long term studies analysing patients who survived three to four months after acute myocardial infarction. 6These contradictory observations probably relate to differing characteristics of persistent negative T waves as opposed to reversible negative T waves that normalise over time. Spontaneous normalisation of negative T waves is a marker of myocardial viability 7 8 and predicts recovery of regional dysfunction. 10Functional recovery is greater in the presence of early T wave normalisation. 11 Persistent negative T waves have been found to be associated with transmural necrosis.12 Accordingly, we hypothesised that persistent versus early or delayed normalisation of negative T waves after a first acute myocardial infarction are determined by the myocardial state, the treatment strategy, or both. METHODS Patient selectionThe study population consisted of 127 consecutive patients prospectively enrolled with the following inclusion criteria: diagnosis of acute myocardial infarction (typical chest pain >...

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“…Various ECG parameters at rest or during exercise were applied to assess myocardial viability or recovery of functionfor example, QT dispersion and T-wave normalization 9,10 -in a population with severely diseased but mostly patent arteries. The extent of Q waves in the resting ECG was used to assess a QRS score (Selvester Score) to predict infarct size and LV function after myocardial infarction (MI).…”

Section: Introductionmentioning

confidence: 99%

Resting 12-lead electrocardiogram as a reliable predictor of functional recovery after recanalization of chronic total coronary occlusions

et al. 2005

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SummaryBackground: A major goal of revascularization is the recovery of left ventricular (LV) function. Nuclear imaging techniques are widely used for detecting recovery of function with a good sensitivity, but only moderate specificity. Predictors of recovery in chronic total coronary occlusions (CTO) are not investigated.Hypothesis: The 12-lead-resting electrocardiogram (ECG) is a predictor of LV recovery after successful recanalization of CTO.Methods: Successful recanalization of CTO was performed in 127 patients. Of these, 62 patients, who constitute the study group, had impaired regional wall motion prior to recanalization. The 12-lead resting ECG was evaluated for Q-wave areas and parameters of QT dispersion. Impairment of regional wall motion was evaluated by LV angiogram at baseline and at follow-up.Results: Angiographic follow-up after 5 ± 1.4 months documented reocclusion in eight patients. Complete follow-up with a patent coronary artery and an ECG without bundlebranch block was available in 43 patients. Wall motion severity index (WMSI) improved from Ϫ2.92 ± 0.28 to Ϫ1.34 ± 0.61 (p < 0.001) in patients without Q waves, whereas it was unchanged in patients with Q waves (Ϫ3.01 ± 0.30 and Ϫ2.81 ± 0.32). Absence of Q waves at baseline predicted recovery of regional wall motion with 89% sensitivity and 67% specifici-

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T wave normalization in infarct-related electrocardiographic leads during exercise testing for detection of residual viability

Abstract: Exercise-induced TWN on IRLs at low work loads is a sensitive and specific index for the presence of residual viability in the infarct area. Sensitivity and diagnostic accuracy of this sign are higher for anterior infarctions.

Cited by 27 publications

References 24 publications

Normalization of Negative T Waves in the Chronic Stage of Q Wave Anterior Myocardial Infarction as a Predictor of Myocardial Viability

Normalization of Negative T Waves in the Chronic Stage of Q Wave Anterior Myocardial Infarction as a Predictor of Myocardial Viability

Determinants of persistent negative T waves and early versus late T wave normalisation after acute myocardial infarction

Resting 12-lead electrocardiogram as a reliable predictor of functional recovery after recanalization of chronic total coronary occlusions

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