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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

View larger version (14K): [in a new window]   Figure 1 Schematic representation of tomographic segments. BASE: basal level slice of left ventricle; MID: middle level slice of left ventricle.

View larger version (52K): [in a new window]   Figure 2 Patient No. 1 (Group A). Left panel: Electrocardiograms recorded at rest (R) and at peak exercise (Ex). Exercise-induced ST-segment elevations (V2-3) with reciprocal ST-segment depressions (II, III, aVF) were observed. Right panel: NH3-PET images showed perfusion defects in the anterior and apical walls. Increased FDG uptake was observed within the hypoperfused area.

View larger version (61K): [in a new window]   Figure 3 Patient No. 8 (Group A). Left panel: Electrocardiograms recorded at rest (R) and at peak exercise (Ex). Exercise-induced ST-segment elevations (II, III, aVF) with ST-segment depressions (aVL, V4-6) were observed. Right panel: NH3-PET images showed perfusion defects in the inferior wall. Increased FDG uptake was observed within the hypoperfused area.

View larger version (11K): [in a new window]   Figure 4 The FDG Uptake Index in hypoperfused segments in both groups. N: Upper limit of the normal range of the FDG Uptake Index (0.575); *p < 0.0001.