title: Myocardial viability in patients with thrombolyzed myocardial infarction: is it assessable by predischarge exercise electrocardiography test?
abstract: BACKGROUND
  Most studies concerning exercise electrocardiography (ECG) testing after acute myocardial infarction (AMI) were carried out in the prethrombolytic era. ST-segment elevation in the infarction area during exercise has usually been interpreted as indicating the presence of dyskinesia as a result of extensive left ventricle damage.
  
  
  OBJECTIVE
  This study was undertaken to evaluate the contributions of exercise-induced ST-segment elevation and T-wave pseudonormalization to the assessment of myocardial viability in patients with thrombolyzed myocardial infarction (MI), compared with low-dose dobutamine echocardiography.
  
  
  METHODS
  The study comprised 52 consecutive patients with AMI treated with thrombolysis. All patients underwent low-dose dobutamine echocardiography and symptom-limited exercise testing before discharge.
  
  
  RESULTS
  Nineteen patients showed ST-segment elevation (Group 1), 9 showed isolated T-wave pseudonormalization (Group 2), and 24 patients did not exhibit either of these ST-T segment changes (Group 3). Low-dose dobutamine echocardiography revealed evidence of viability in 16 patients (84%) in Group I (p = 0.01), 5 (56%) in Group 2 (p = NS), and 11 patients (46%) in Group 3 (p = NS).
  
  
  CONCLUSIONS
  Exercise-induced ST-segment elevation may contribute to the evaluation of myocardial viability in patients with AMI treated with thrombolysis. However, in the absence of exercise-induced ST-segment elevation, further noninvasive studies might be indicated to assess myocardial viability.
authors.affiliation: Karolinska Institutet, Department of Cardiology, Stockholm Söder Hospital, Sweden.
authors.forename: B A
authors.initials: BA
authors.lastname: Samad
authors.forename: K
authors.initials: K
authors.lastname: Jensen-Urstad
authors.forename: J
authors.initials: J
authors.lastname: Hulting
authors.forename: H
authors.initials: H
authors.lastname: Ruiz
authors.forename: J
authors.initials: J
authors.lastname: Höjer
authors.forename: F
authors.initials: F
authors.lastname: Bouvier
authors.forename: M
authors.initials: M
authors.lastname: Jensen-Urstad
mesh_terms: D000368:Aged; D004280:Dobutamine; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000188:drug therapy; D015912:Thrombolytic Therapy
chemical_list: D004280:Dobutamine