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CLINICAL STUDIES

Reciprocal ST-segment depression associated with exercise-induced ST-segment elevation indicates residual viability after myocardial infarction

Akira Nakano, MD^*, Jong-Dae Lee, MD^*, Hiromasa Shimizu, MD^*, Tatsuro Tsuchida, MD, Yoshiharu Yonekura, MD, Yasushi Ishii, MD and Takanori Ueda, MD^*

^* First Department of Internal Medicine, Fukui Medical University, 23 Shimoaizuki, Matsuoka-cho, Fukui, 910-1193, Japan
Department of Radiology, Fukui Medical University, 23 Shimoaizuki, Matsuoka-cho, Fukui, 910-1193, Japan
Biomedical Imaging Research Center, Fukui Medical University, 23 Shimoaizuki, Matsuoka-cho, Fukui, 910-1193, Japan

Manuscript received January 13, 1998; revised manuscript received September 18, 1998, accepted October 30, 1998.

Reprint requests and correspondence: Dr. Jong-Dae Lee, The First Department of Internal Medicine, Fukui Medical University, 23, Shimoaizuki, Matsuoka-cho, Fukui, 910-1193, Japan
jdlee{at}fmsrsa.fukui-med.ac.jp

OBJECTIVES

We evaluated the clinical significance of reciprocal ST-segment depression associated with exercise-induced ST-segment elevation for detecting residual viability within the infarcted area.

BACKGROUND

Although the relation between residual viability and exercise-induced ST-segment elevation has been described, there are no reports focusing on the relation between myocardial viability and reciprocal ST-segment depression associated with exercise-induced ST-segment elevation.

METHODS

We evaluated regional blood flow and glucose utilization using N-13 ammonia (NH3) and F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) in 30 patients with a previous Q-wave myocardial infarction (anterior in 15, inferior in 15). All subjects had single-vessel disease and had exercise-induced ST-segment elevations (1 mm) in electrocardiographic leads.

RESULTS

Reciprocal ST-segment depression (1 mm) was present in 16 patients (Group A; anterior in 6, inferior in 10) but not in the remaining 14 patients (Group B). The degree of exercise-induced ST-segment elevation (1.8 ± 0.2 vs. 2.0 ± 0.2 mm) and the time from the onset of infarction to the study (75 ± 49 vs. 74 ± 52 days) did not differ between groups. There were no significant differences between groups in the severity of left ventricular dysfunction and the residual luminal narrowing in the infarct-related artery (45 ± 21 vs. 48 ± 25%). The presence and site of infarction were confirmed by NH3-PET in all patients. FDG-PET demonstrated residual tissue viability within infarct-related area in all patients in Group A and in 3 (21%) of 14 patients in Group B (p < 0.01). The sensitivity, specificity and accuracy of reciprocal ST-segment depression associated with exercise-induced ST-segment elevation for detecting residual viability were 84%, 100% and 90%, respectively.

CONCLUSIONS

The occurrence of reciprocal ST-segment depression associated with exercise-induced ST segment elevation in patients with a previous Q-wave infarction who had single-vessel disease indicates residual tissue viability within the infarct-related area.

Abbreviations and Acronyms   FDG = F-18 fluorodeoxyglucose   NH3 = N-13 ammonia   PET = positron emission tomography   WMAS = wall motion abnormality score

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