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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
Author(s) -
Manrique Alain,
Koning René,
Hitzel Anne,
Cribier Alain,
Véra Pierre
Publication year - 2001
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/s1388-9842(01)00186-6
Subject(s) - medicine , cardiology , myocardial infarction , ejection fraction , radionuclide angiography , perfusion , heart failure , st elevation , nuclear medicine
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 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. 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 software (QGS). Results: Twenty‐one out of 50 patients (42%, G1) had significant stress‐induced ST‐elevation (>1 mm 80 ms after J point in at least 2 ECG leads with Q wave), and 29/50 (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 compared to G2 (LVEF: 39±10% vs. 49±11%, P ‐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 (post‐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.