TY - JOUR
T1 - Therapeutic significance of exercise-induced ST-segment elevation in patients without previous myocardial infarction
AU - Gallik, Donna M.
AU - Mahmarian, John J.
AU - Verani, Mario S.
PY - 1993/7/1
Y1 - 1993/7/1
N2 - Twelve patients with exercise-induced ST-segment elevation without prior myocardial infarction, electrocardiographic evidence of left ventricular hypertrophy or left bundle branch block underwent thallium-201 tomography immediately after exercise and 4 hours later. Coronary angiography and left ventriculography were performed within an average of 8 days of exercise testing. Five patients had repeat exercise thallium-201 tomography after medical therapy or revascularization. All patients had large, reversible perfusion defects (average defect size 33.5 ± 13%), with 11 of 12 patients having a ≥25% stress perfusion defect. In 10 patients with atherosclerotic coronary artery disease, the average stenosis of the involved vessel was 93 ± 9% (range 70 to 100). The electrocardiographic leads with ST-segment elevation predicted the site of reversible hypoperfusion. Two patients had extensive, reversible anterior hypopeifusion due to exercise-induced spasm of minimally stenosed left anterior descending coronary arteries. Follow-up exercise testing in 5 patients showed abolition of reversible hypoperfusion and ST changes after medical therapy or revascularization. In patients without prior myocardial infarction, exercise-induced ST-segment elevation signifies extensive, reversible hypoperfusion that can be abolished by revascularization in patients with critical coronary stenoses and by medical therapy in those with coronary vasospasm.
AB - Twelve patients with exercise-induced ST-segment elevation without prior myocardial infarction, electrocardiographic evidence of left ventricular hypertrophy or left bundle branch block underwent thallium-201 tomography immediately after exercise and 4 hours later. Coronary angiography and left ventriculography were performed within an average of 8 days of exercise testing. Five patients had repeat exercise thallium-201 tomography after medical therapy or revascularization. All patients had large, reversible perfusion defects (average defect size 33.5 ± 13%), with 11 of 12 patients having a ≥25% stress perfusion defect. In 10 patients with atherosclerotic coronary artery disease, the average stenosis of the involved vessel was 93 ± 9% (range 70 to 100). The electrocardiographic leads with ST-segment elevation predicted the site of reversible hypoperfusion. Two patients had extensive, reversible anterior hypopeifusion due to exercise-induced spasm of minimally stenosed left anterior descending coronary arteries. Follow-up exercise testing in 5 patients showed abolition of reversible hypoperfusion and ST changes after medical therapy or revascularization. In patients without prior myocardial infarction, exercise-induced ST-segment elevation signifies extensive, reversible hypoperfusion that can be abolished by revascularization in patients with critical coronary stenoses and by medical therapy in those with coronary vasospasm.
UR - http://www.scopus.com/inward/record.url?scp=0027168435&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0027168435&partnerID=8YFLogxK
U2 - 10.1016/0002-9149(93)90209-U
DO - 10.1016/0002-9149(93)90209-U
M3 - Article
C2 - 8517412
AN - SCOPUS:0027168435
VL - 72
SP - 1
EP - 7
JO - American Journal of Cardiology
JF - American Journal of Cardiology
SN - 0002-9149
IS - 1
ER -