Dissociation between regional myocardial dysfunction and ECG changes during myocardial ischemia induced by exercise in patients with angina pectoris

Efficacy of Oral Dipyridamole Cinemagnetic Resonance Imaging in Detecting Coronary Artery Disease - Initial Experience

“…Of the remaining 3 territories, post-DP C-MRI showed systolic wall thick ening abnormality in 2 territories (sensitivity = 67%) as seen in figure 3. animal and human studies have shown abnormal regional left ventricular function to be the earliest sign of both subendocardial and transmurai ischemia [1,3].…”

“…There was a trend toward superiority utilizing the qualitative cine-method rather than that of quantita tive systolic wall tickening. DP C-MRI appears to be a promising method for the evaluation of left ventricular cardiac function.cardial and transmurai ischemia [1][2][3]. Currently used noninvasive methods for the evaluation of regional myo cardial function include radionuclide ventriculography and echocardiography.…”

Sequence of Electrocardiographic and Acoustic Cardiographic Changes and Angina during Coronary Occlusion and Reperfusion in Patients Undergoing Percutaneous Coronary Intervention

“…In prior studies, ventricular dysfunction measured by a rise in ventricular filling pressure or abnormal wall motion on echocardiography was shown to occur earlier than ECG changes and angina during ischemia induced by PCI 6–8 or exercise/atrial pacing, 9–12 regardless of the duration or intensity of ischemia. Also, ventricular dysfunction persisted longer than ischemic ST changes after coronary reperfusion 7,13,14 .…”

“…Although the 12‐lead electrocardiogram (ECG) has been considered the gold standard for detection of myocardial ischemia that is likely to develop into infarction, nearly half of patients presenting to an emergency department with chest pain who subsequently develop biomarker evidence of infarction have an initial nondiagnostic ECG 1,2 . Previous studies suggest that ventricular function can be severely impaired without ST‐segment changes or angina during ischemia 3–12 . During ischemia induced by percutaneous coronary intervention (PCI), about 40% of patients developed ventricular dysfunction without ischemic ST changes 6–8 .…”

“…Independent of electrocardiographic changes caused by the differences in electrical action potentials between ischemic and nonischemic cells, ventricular dysfunction has been shown to occur due to the loss of compliance of the ischemic zone of the left ventricle during ischemia 6–12 . The combined use of electrical and functional changes of ischemia may help the early detection of ischemia and a timely provision of treatment, especially in patients with uninterpretable ECGs or those without angina.…”