HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hahalis, G. Articles by Manolis, A. S. Search for Related Content PubMed PubMed Citation Articles by Hahalis, G. Articles by Manolis, A. S.

CLINICAL STUDY

Contribution of the sT elevation/T-wave normalization in q-wave leads during routine, pre-discharge treadmill exercise test to patient management and risk stratification after acute myocardial infarction

A 2.5-year follow-up study

George Hahalis, MD^*, Christos Stathopoulos, MD^*, Dimitrios Apostolopoulos, MD, Pavlos Vasilakos, MD, Dimitrios Alexopoulos, MD, FESC, FACC^* and Antonis S. Manolis, MD, FESC, FACC^*,*

^* Department ofCardiologyRio, Patras, Greece
Department ofNuclear Medicine, Patras University Medical School, Rio, Patras, Greece

Manuscript received August 2, 2001; revised manuscript received March 19, 2002, accepted April 5, 2002.

^* Reprint requests and correspondence: Dr. Antonis S. Manolis, Professor and Director of Cardiology, 41 Kourempana Street, Agios Dimitrios 173 43, Athens, Greece.
asm{at}otenet.gr

OBJECTIVES: This study investigated whether ST-segment elevation and T-wave normalization (TWN) in Q-wave leads on pre-discharge exercise electrocardiogram (ECG) can contribute to patient management after a recent myocardial infarction (MI).

BACKGROUND: The clinical relevance of these exercise ECG changes remains controversial despite accumulating evidence of their association with myocardial viability. Because discrepancies of previous studies may depend on patient selection, the value of these ST/T abnormalities in the thrombolytic era should be better defined.

METHODS: One-hundred one patients, age 58 ± 11 years, with a recent, first Q-wave MI (57% thrombolyzed, ejection fraction 43 ± 7%) underwent pre-discharge, submaximal treadmill testing followed, in the absence of severe ischemia, by dobutamine stress echocardiography, thallium-201 single photon emission computed tomography, and coronary angiography.

RESULTS: ST elevation at peak exercise, but not TWN, was associated with more severe infarctions as indicated by higher peak creatine kinase (p < 0.05) and with a greater number of scarred segments both on echocardiography (p < 0.05) and scintigraphy (p < 0.01). However, the incidence of myocardial viability and ischemia did not differ between groups with or without these ST/T changes. Anterior infarction location and 3 echocardiographically scarred segments were among the independent predictors of ST elevation at peak ergometric exercise. During follow-up (31 ± 13 months), the rate of hard events was low (8%) and similar between the study groups.

CONCLUSIONS: In patients after acute Q-wave MI without severe ischemia according to clinical and standard ECG criteria, exercise-induced ST elevation, but not TWN, is associated with larger infarctions. The contribution of these ST/T abnormalities toward identifying patients with myocardial viability or ischemia and determining risk stratification is poor. In-hospital management of such patients based on routine clinical practice is sufficient for selection of a population with a relatively low long-term risk.

Abbreviations and Acronyms   CK   creatine kinase   DSE   dobutamine stress echocardiography   ECG   electrocardiogram/electrocardiographic   ET   exercise test/testing   HR   heart rate   LV   left ventricular   MI   myocardial infarction   201Tl-SPECT   thallium-201 single photon emission computed tomography   TWN   T-wave normalization   WMSI   wall motion score index

This article has been cited by other articles:

				H. Yang, M. Pu, D. Rodriguez, D. Underwood, B. P. Griffin, V. Kalahasti, J. D. Thomas, and R. C. Brunken Ischemic and viable myocardium in patients with Non-Q-Wave or Q-Wave myocardial infarction and left ventricular dysfunction: A clinical study using positron emission tomography, echocardiography, and electrocardiography J. Am. Coll. Cardiol., February 18, 2004; 43(4): 592 - 598. [Abstract] [Full Text] [PDF]