title: Comparison of high risk stress myocardial perfusion imaging findings in men with rapid versus prolonged recovery of ST-segment depression after exercise stress testing.
abstract: ST-segment depression during stress testing predicts future risk for adverse cardiovascular events and routinely prompts further noninvasive imaging or invasive evaluation for coronary artery disease (CAD). A subset of patients develop ST depression at peak exercise that rapidly resolves early in the recovery period (ST-rapid). The goal of this study was to compare the prevalence of single-photon emission computed tomographic myocardial perfusion imaging (MPI) findings in patients with ST-rapid to those with prolonged ST depression (ST-prolonged) and those without ST depression (ST-normal). A total of 637 men without previous CAD and with interpretable rest electrocardiograms referred for exercise stress MPI were included in this study. ST depression was defined as > or =1-mm ST depression occurring 80 ms after the J point at peak exercise. ST-rapid was defined as ST depression with recovery of the ST depression by 1 minute into recovery. Men with ST-rapid were younger (55.4 +/- 7.6 vs 62.6 +/- 9.6 years, p <0.001) and had better exercise capacity (11.2 +/- 2.8 vs 9.4 +/- 3.0 METs, p <0.001) than men with ST-prolonged. Compared to ST-prolonged, ST-rapid was associated with significantly less mild CAD (summed stress score > or =4; 27% vs 47%, p = 0.02), severe CAD (summed stress score >8; 9% vs 29%, p = 0.004), and a composite of high-risk MPI findings (summed stress score >8 or ejection fraction <40%; 11% vs 32%, p = 0.003). There were no significant differences in exercise capacity, the presence of CAD, or the composite of high-risk MPI findings between men with ST-rapid and those with ST-normal. In conclusion, men who developed ST-rapid during exercise stress testing had markedly fewer abnormal and high-risk MPI findings compared to those with prolonged ST depression. In fact, the prevalence of MPI abnormalities in men with ST-rapid was similar to that in men with normal electrocardiographic responses to exercise.
authors.affiliation: University of Chicago Medical Center, Chicago, Illinois, USA.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Rich
authors.forename: Stuart
authors.initials: S
authors.lastname: Chen
authors.forename: R Parker
authors.initials: RP
authors.lastname: Ward
mesh_terms: D017677:Age Distribution; D000368:Aged; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology; D016208:Databases, Factual; D004562:Electrocardiography; D005080:Exercise Test / Q000379:methods*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D005082:Physical Exertion / Q000502:physiology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D012016:Reference Values; D018570:Risk Assessment; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*