[Significance of electrocardiographic projection of ST-segment depression during exercise test in the prediction of the location of regional myocardial ischemia].
There is still some controversy whether ST segment depression during exercise testing might predict the location of myocardial ischemia. From a population of 1196 patients who underwent myocardial 99mTc-tetrofosmin exercise SPECT scintigraphy, 22 consecutive patients (20 males and 2 females, mean age 54 +/- 10 years) with no previous myocardial infarction, positive exercise testing (> or = 1 mm ST segment depression) performed in pharmacologic wash-out and angiographically documented isolated single vessel coronary artery disease (> or = 70% diameter stenosis in a main coronary artery) were selected. None of the patients showed > or = 1 mm ST segment depression exclusively in inferior leads (II-III-aVF). Eight patients (36%) showed > or = 1 mm ST segment depression exclusively in precordial leads (Group 1). The remaining 14 patients (64%) showed > or = 1 mm ST segment depression in both inferior and precordial leads (Group 2). No differences between groups were observed regarding peak exercise test parameters such as heart rate (124 +/- 28 vs 135 +/- 21 b/min, NS), rate-pressure product (22592 +/- 5323 vs 23118 +/- 4197 mmHg x b/min, NS) and exercise time (14.5 +/- 3.9 vs 15.1 +/- 2.9 min, NS) and the number of stress-induced reversible and partially reversible defects (3.3 +/- 3.4 vs 4.6 +/- 2.8, NS). All reversible and partially reversible defects were seen in the related coronary artery stenosis region. Among Group 1, 5 patient (62.5%) showed a > or = 70% stenosis of left descending coronary artery, 1 patient (12.5%) of left circumflex and 2 patients (25%) of right coronary artery. Similarly, among Group 2, 9 patients (64.3%) showed a significant stenosis of left descending coronary artery, 1 patient (7.1%) of left circumflex and 4 patients (28.6%) of right coronary artery. Thus, we were not able to show a relation between exercise ST segment depression and the location of myocardial ischemia as assessed by myocardial 99mTc-tetrofosmin SPECT scintigraphy in a population of patients selected on the basis of single coronary artery disease.
Azzarelli
S
S
Istituto di Cardiologia, Facoltà di Medicina e Chirurgia, Università degli Studi, Catania.
Galassi
A R
AR
Mammana
C
C
Foti
R
R
Tamburino
C
C
Mammana
M L
ML
Calvi
V
V
Musumeci
S
S
Giuffrida
G
G
D000328:Adult; D017023:Coronary Angiography; D003627:Data Interpretation, Statistical; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000000981:diagnostic imaging; D015899:Tomography, Emission-Computed, Single-Photon
Significato della sede elettrocardiografica del sottoslivellamento del tratto ST durante prova da sforzo nel predire la distribuzione dell'ischemia regionale miocardica.