title: QRST integral analysis of body surface electrocardiographic mapping for assessing exercise-induced changes in the spatial distribution of local repolarization properties in patients with coronary artery disease and in patients with previous anterior infarction.
abstract: We studied resting, postexercise, difference (postexercise - rest) QRST isointegral maps, and the correlation coefficient between resting and postexercise maps. Study I Fifteen controls and 48 patients without previous myocardial infarction were studied. In coronary syndrome X group (n = 14), no patients showed an abnormally negative area on the postexercise map. In coronary ST depression group (n = 26), 12 patients (46%) showed an abnormally negative area on the postexercise map, and the correlation coefficient was low. Although all control, syndrome X, and coronary ST depression patients showed the global-downward type of difference map, coronary ST elevation patients (n = 8) showed the right-downward and left-upward type, right-upward and left-downward type, or reversed saddle type. Coronary ST depression is related to a globally marked decrease in local repolarization forces. Coronary ST elevation is associated with multidirectional changes in local repolarization forces. Study II Fifty-one patients with previous anterior infarction (29 with residual ischemia and 22 without) were studied. The incidence of the global-positive type of maps was increased and that of the saddle-type map was decreased from rest to postexercise in both groups. The global-upward type or right-downward and left-upward type of difference map was observed in both groups, but the reversed saddle type, right-upward and left-downward type, or global-downward type was observed in the residual ischemia group (34%, 24%, and 14%, respectively). Residual ischemia causes multidirectional changes or a global decrease in local repolarization forces. In both studies, multidirectional changes in local repolarization forces may be related to the vulnerability to ventricular arrhythmias.
authors.affiliation: First Department of Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Miyakoda
authors.forename: T
authors.initials: T
authors.lastname: Kinugawa
authors.forename: K
authors.initials: K
authors.lastname: Ogino
authors.forename: M
authors.initials: M
authors.lastname: Mori
authors.forename: A
authors.initials: A
authors.lastname: Endo
authors.forename: M
authors.initials: M
authors.lastname: Kato
authors.forename: T
authors.initials: T
authors.lastname: Kato
authors.forename: S
authors.initials: S
authors.lastname: Osaki
authors.forename: I
authors.initials: I
authors.lastname: Hisatome
authors.forename: C
authors.initials: C
authors.lastname: Shigemasa
mesh_terms: D000328:Adult; D000368:Aged; D000790:Angiocardiography; D018780:Body Surface Potential Mapping / Q000379:methods*; D002986:Clinical Trials as Topic; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003627:Data Interpretation, Statistical; D017079:Exercise Tolerance; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D013794:Thallium Radioisotopes
chemical_list: D013794:Thallium Radioisotopes