Specificity and sensitivity of exercise-induced st segment elevation for detection of residual viability: Comparison with fluorodeoxyglucose and positron emission tomography

Margonato, Alberto; Chierchia, Sergio; Xuereb, Robert G.; Xuereb, Mariosa; Fragasso, Gabriele; Cappelletti, Alberto; Landoni, Claudio; Lucignani, Giovanni; Fazio, Ferruccio

doi:10.1016/0735-1097(94)00539-3

Cited by 86 publications

(39 citation statements)

References 26 publications

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“…On reformatted short-axis, vertical long-axis, and horizontal long-axis slices, encompassing the entire left ventricle, the left ventricle was subdivided into six segments (anterior, apical, inferior, posterior, lateral, septal), as previously published [12]. Two independent observers, blinded to the results of coronary angiography, semiquantitatively graded tracer uptake for each segment in two planes in consensus: normal uptake (grade 0), mildly abnormal (grade 1), moderately abnormal (grade 2) or severely abnormal (grade 3) of uptake.…”

Section: Mpi Pet Acquisitionmentioning

confidence: 99%

Diagnostic accuracy of myocardial perfusion imaging with single photon emission computed tomography and positron emission tomography: a comparison with coronary angiography

Husmann

Wiegand

Valenta

et al. 2007

Int J Cardiovasc Imaging

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Objective The aim of this study was to compare the diagnostic accuracy of myocardial perfusion imaging (MPI) by positron emission tomography (PET) with the diagnostic accuracy of MPI by single photon emission computed tomography (SPECT) in two comparable patient cohorts, using coronary angiography (CA) as the standard of reference. Methods A ''SPECT-group'' of 80 patients (15 female, 65 male; mean age 60 ± 9 years) and a ''PET-group'' of 70 patients (14 female, 56 male; mean age 57 ± 10 years) underwent a one day stress/rest examination either with attenuation-corrected 13 N-ammonia PET or attenuation-corrected 201 TlCl SPECT or 99m Tc-hexakismethoxy-isobutyl-isonitril (MIBI) SPECT. PET and SPECT results were semiquantitatively graded using a 6-segment heart model. All patients underwent CA, and stenoses were graded as a diameter reduction C50%. Results Coronary findings between both groups did not significantly differ at CA. For the SPECTgroup overall sensitivity and specificity for localisation of stenoses was 77% and 84%. Respective values for the PET-group were 97% and 84%. The specificity of MPI by SPECT in the detection of ischemia was 74% and 91% for MPI by PET. The diagnostic accuracy of MPI improves when the individual coronary dominance and previous coronary revascularisations are taken into account. Conclusion MPI by 13 N-ammonia PET is more sensitive in the detection and localisation of coronary stenoses, and more specific in the detection of ischemia than MPI by 201 TlCl/ 99m MIBI SPECT.

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Section: Mpi Pet Acquisitionmentioning

confidence: 99%

Diagnostic accuracy of myocardial perfusion imaging with single photon emission computed tomography and positron emission tomography: a comparison with coronary angiography

Husmann

Wiegand

Valenta

et al. 2007

Int J Cardiovasc Imaging

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“…[7][8][9] Positron emission tomography studies have shown that a majority of recently infarcted myocardial regions retain residual metabolic activity in patients showing ST-segment elevation. 11 Therefore changes in the action potential of the viable myocardium in the infarcted area may account for ST-segment elevation.…”

Section: Mechanism Of Exercise-induced St-segment Elevationmentioning

confidence: 99%

“…It has been interpreted as a sign of myocardial ischemia, 1,2 left ventricular wall motion abnormality (WMA) 3,4 or both, 5,6 and recent studies have suggested that ST-segment elevation during stress reflects myocardial viability. [7][8][9][10][11] Stress echocardiography has been proposed as a useful technique for the assessment of myocardial ischemia, left ventricular dysfunction and myocardial viability, but although exercise and pharmacological stress, such as dobutamine and dipyridamole, are widely used in stress echocardiography, there has not been a comparative study of the significance of the stressinduced ST-segment elevation of exercise, dobutamine and dipyridamole in identical patients. Dobutamine and dipyridamole differ in their mechanism of inducing myocardial ischemia: dobutamine is a -receptor agonist that increases myocardial oxygen consumption, whereas dipyridamole causes vasodilation and induces vertical and horizontal blood steals.…”

mentioning

confidence: 99%

Stress-Induced ST-Segment Elevation Following Myocardial Infarction and Its Role in Wall Motion Abnormality, Myocardial Ischemia and Viability. Comparison of Response to Exercise, Dobutamine and Dipyridamole.

et al. 2001

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tress-induced ST-segment elevation is a common finding in patients after myocardial infarction (MI), but its mechanism is still controversial. It has been interpreted as a sign of myocardial ischemia, 1,2 left ventricular wall motion abnormality (WMA) 3,4 or both, 5,6 and recent studies have suggested that ST-segment elevation during stress reflects myocardial viability. [7][8][9][10][11] Stress echocardiography has been proposed as a useful technique for the assessment of myocardial ischemia, left ventricular dysfunction and myocardial viability, but although exercise and pharmacological stress, such as dobutamine and dipyridamole, are widely used in stress echocardiography, there has not been a comparative study of the significance of the stressinduced ST-segment elevation of exercise, dobutamine and dipyridamole in identical patients. Dobutamine and dipyridamole differ in their mechanism of inducing myocardial ischemia: dobutamine is a -receptor agonist that increases myocardial oxygen consumption, whereas dipyridamole causes vasodilation and induces vertical and horizontal blood steals. 12 The purpose of the present study was to determine the relationship between ST-segment elevation Japanese Circulation Journal Vol. 65, December 2001 and wall motion response during exercise, dobutamine and dipyridamole stresses, and to examine the mechanism of stress-induced ST-segment elevation following MI. MethodsTwenty-five consecutive patients, 24 men and 1 woman, aged 53±10 years, were prospectively enrolled. The criteria for recruitment were (1) admission to hospital with a diagnosis of first anterior acute MI and (2) abnormal Q wave in at least 2 leads on the electrocardiogram (ECG) performed in conjunction with stress echocardiography. Patients with bundle branch block (n=2), left ventricular hypertrophy (n=2), unstable angina (n=1), left ventricular failure (n=1), bronchial asthma (n=1), and those unable to exercise adequately (n=3) were excluded. One patient developed serious ventricular arrhythmia during a low dose dobutamine test (10 g·kg -1 ·min -1 ) was also excluded. Sixteen patients were treated with thrombolytic agents within 24 h from the beginning of symptoms and 5 patients underwent coronary angioplasty within 48 h from the onset of MI. None of the patients had a coronary stent implanted. Each patient underwent, in random order, exercise, dobutamine and dipyridamole echocardiography on different days and under the same medication. All stress tests were performed 4-6 weeks after the onset of MI. All antianginal drugs, such as -adrenergic blocking agents, nitrates and calcium antagonists, were discontinued on the day before the stress Stress-induced ST-segment elevation following myocardial infarction (MI) has been correlated with myocardial ischemia, viability and wall motion abnormality, but its mechanism is still unclear, so the present study compared ST-segment elevation and wall motion response during exercise, dobutamine and dipyridamole stresses. Twentyfive patients with their first anterior MI ...

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“…This increase is reflected in a prolongation in QTd. [5][6][7] We therefore sought to determine whether exercise-induced changes in QTd can serve as an indicator of ischemic but viable myocardium in infarct areas.…”

Section: Introductionmentioning

confidence: 99%

Enhanced detection of ischemic but viable myocardium by qt interval dispersion on treadmill exercise electrocardiograms of patients with healed anterior wall myocardial infarcts

Koide

Yotsukura

Tajino

et al. 2000

Clinical Cardiology

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Background: The presence of ischemic but viable myocardium in infarcted areas is an important indication for coronary revascularization, but is often difficult to detect with the use of treadmill exercise electrocardiography (ECG). Hypothesis: QT interval dispersion (QTd) is a sensitive method for detecting myocardial ischemia and may improve the accuracy of treadmill exercise ECG testing for detecting ischemic but viable myocardium in infarcted areas. Methods: Forty‐five patients with Q‐wave anterior wall myocardial infarctions who underwent treadmill exercise ECG, exercise reinjection thallium‐201 (201T1) scintigraphy, radionuclide angiocardiography, and coronary angiography 1 month after infarction were enrolled in this study. The presence of viable myocardium in the infarct area was determined by exercise reinjection 201T1 scintigraphy. Patients who had no redistribution in the infarct area after reinjection were included in Group 1, and those with redistribution were included in Group 2. Results: QTd immediately after exercise, and the difference between QTd before and immediately after exercise, were significantly greater in Group 2 than in Group 1. The sensitivity, specificity, and accuracy of conventional ST‐segment depression criteria for detecting viable myocardium in the infarct area were 48,64, and 56%, respectively. The measurement of QTd immediately after exercise (abnormal: ≥ 70 ms; normal: < 70 ms) improved the sensitivity, specificity, and accuracy to 78,82, and 80%, respectively. Conclusions: This novel diagnostic method using QTd‐based criteria significantly improves the clinical usefulness of treadmill exercise ECG testing for detecting ischemic but viable myocardium in infarct areas in patients with healed Q‐wave anterior wall myocardial infarctions.

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Specificity and sensitivity of exercise-induced st segment elevation for detection of residual viability: Comparison with fluorodeoxyglucose and positron emission tomography

Abstract: Exercise-induced ST segment elevation in infarct-related leads has a high specificity and acceptable sensitivity for detection of residual viability within the infarcted area.

Cited by 86 publications

References 26 publications

Diagnostic accuracy of myocardial perfusion imaging with single photon emission computed tomography and positron emission tomography: a comparison with coronary angiography

Diagnostic accuracy of myocardial perfusion imaging with single photon emission computed tomography and positron emission tomography: a comparison with coronary angiography

Stress-Induced ST-Segment Elevation Following Myocardial Infarction and Its Role in Wall Motion Abnormality, Myocardial Ischemia and Viability. Comparison of Response to Exercise, Dobutamine and Dipyridamole.

Enhanced detection of ischemic but viable myocardium by qt interval dispersion on treadmill exercise electrocardiograms of patients with healed anterior wall myocardial infarcts

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