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J Am Coll Cardiol, 2000; 35:352-357
© 2000 by the American College of Cardiology Foundation
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CLINICAL STUDIES

Persistent ST segment depression in precordial leads V5–V6 after Q-wave anterior wall myocardial infarction is associated with restrictive physiology of the left ventricle

Abid Assali, MDa, Samuel Sclarovsky, MDa, Itzhak Herz, MDa, Mordechai Vaturi, MDa, Irit Gilad, PhDa, Alejandro Solodky, MDa, Nili Zafrir, MDa, Yehuda Adler, MDa, Alex Sagie, MDa, Yochai Birnbaum, MDa and David Hasdai, MDa

a Department of Cardiology, Rabin Medical Center, Beilinson Campus, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Manuscript received December 9, 1998; revised manuscript received September 10, 1999, accepted October 27, 1999.

Reprint requests and correspondence: Dr. David Hasdai, Department of Cardiology, Rabin Medical Center (Beilinson Campus), Petah Tiqva, 49100, Israel
dhasdai{at}post.tau.ac.il

OBJECTIVES

To examine the relationship between the persistence of ST segment depression in leads V5–V6 after Q-wave anterior wall myocardial infarction (MI) and the filling pattern of the left ventricle (LV).

BACKGROUND

Precordial ST segment depression predominantly in leads V5–V6 is associated with increased in-hospital morbidity and mortality after acute myocardial ischemia, perhaps due to reduced diastolic distensibility of the LV.

METHODS

We prospectively studied 19 patients after Q-wave anterior wall MI (>6 months). All patients underwent 12-lead ECG recording, symptom-limited treadmill exercise testing with single photon emission computed tomography thallium-201 imaging, transthoracic Doppler echocardiography, cardiac catheterization and measurement of circulating atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels. Patients were classified based on the presence of ST segment depression in leads V5–V6: Group I = ST segment depression <0.1 mV (n = 10); Group II = ST segment depression ≥0.1 mV (n = 9).

RESULTS

Patients in Group II had greater LV end diastolic pressures (32.4 ± 6.5 mm Hg vs. 14.8 ± 6.1 mm Hg; p = 0.0001), higher plasma ANP (44.4 ± 47.1 pg/ml vs. 10.7 ± 14 pg/ml; p = 0.04) and BNP levels (89.4 ± 62.7 pg/ml vs. 23.6 ± 33.1 pg/ml; p = 0.01), greater left atrium area (20.6 ± 3.1 cm2 vs. 17.8 ± 2.4 cm2; p = 0.05), lower peak atrial (A), higher early (E) mitral inflow velocities, a higher E/A ratio and a lower deceleration time (167 ± 44 ms vs. 220 ± 40 ms; p = 0.05). Lung thallium uptake during exercise was more common in Group II (78% vs. 10%, p = 0.04).

CONCLUSIONS

Persistent ST segment depression in leads V5–V6 in survivors of Q-wave anterior wall MI is associated with increased LV filling pressure and a restrictive LV filling pattern.

Abbreviations and Acronyms
  A = peak atrial velocity
  ACE = angiotensin converting enzyme
  AMI = acute myocardial infarction
  ANP = atrial natriuretic peptide
  BNP = brain natriuretic peptide
  DT = decceleration time
  E = peak inflow early velocity
  E/A = ratio of E and A
  FS = fractional shortening
  LV = left ventricle or ventricular
  LVEDP = left ventricular end diastolic pressure
  LVEF = left ventricular ejection fraction
  MI = myocardial infarction
  SPECT = single photon emission computed tomography




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J. Am. Coll. Cardiol., August 7, 2002; 40(3): 575 - 576.
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