Normalization of abnormal T-waves during stress testing does not identify patients with reversible perfusion defects.
OBJECTIVE
To determine if T-wave normalization during exercise or dobutamine stress testing identified patients with myocardial ischemia as indicated by reversible perfusion defects.


METHODS
Exercise or dobutamine stress tests with perfusion scintigraphy were performed in 1,173 patients with abnormal T-waves on their baseline electrocardiograms. The results of perfusion scintigraphy were compared in patients with and without stress-induced T-wave normalization.


RESULTS
Only 33 of 270 patients with reversible perfusion defects (12.2%) had T-wave normalization during stress while 76.4% of 140 patients who had T-wave normalization during stress did not have a reversible perfusion defect. Results were similar for patients who did or did not reach 85% of their maximal predicted heart rate, for patients with and without Q-wave infarction on the baseline EKG and for patients who did or did not have ischemic ST-segment depression during stress.


CONCLUSIONS
T-wave normalization during stress testing has low sensitivity and poor positive predictive value for stress-induced reversible myocardial ischemia.
Loeb
Henry S
HS
Department of Cardiology, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois 60141, USA. HSL4134@yahoo.com
Friedman
Nicholas C
NC
D000368:Aged; D001285:Atropine; D001794:Blood Pressure / Q000187:drug effects; D002316:Cardiotonic Agents; D016022:Case-Control Studies; D004280:Dobutamine; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006329:Heart Conduction System / Q000187:drug effects / Q000503:physiopathology*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D015425:Myocardial Reperfusion; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D012044:Regression Analysis; D012107:Research Design; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013312:Stress, Physiological / Q000150:complications; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon
D002316:Cardiotonic Agents; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D004280:Dobutamine; C078700:technetium tc-99m tetrofosmin; D001285:Atropine; D017256:Technetium Tc 99m Sestamibi