Viability of Q-wave infarcted myocardium with restored positive and persistent negative T waves after optimal revascularization compared with dobutamine stress echocardiography

Watanabe, S.; Kawamura, Yutaka; Watanabe, Y.; Tanaka, Kimio; Tanaka, Kazushi; Takei, Yasuhiko; Ejiri, Nariaki; Shimada, Kazuyuki

doi:10.1016/s0002-9149(99)00601-3

Cited by 7 publications

(3 citation statements)

References 13 publications

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“…Watanabe et al [16]attempted to clarify the clinical difference in viability of myocardium with negative and positive T waves in patients with optimal revascularization of infarct-related arteries in the chronic phase of Q wave MI by low-dose dobutamine stress echocardiography. They concluded that the restored T waves in Q wave MI indicate a significantly greater amount of viable myocardium than the negative T waves, showing better regional wall motion improvement with low-dose dobutamine stress.…”

Section: Discussionmentioning

confidence: 99%

“…They concluded that the restored T waves in Q wave MI indicate a significantly greater amount of viable myocardium than the negative T waves, showing better regional wall motion improvement with low-dose dobutamine stress. They suggested that when there is restenosis of the left anterior descending artery, with positive T waves in precordial leads, the patient should receive interventional therapy, but if there are negative T waves and optimal patency of the vessel, it is not necessary [16]. …”

Section: Discussionmentioning

confidence: 99%

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Normalization of Negative T Waves in the Chronic Stage of Q Wave Anterior Myocardial Infarction as a Predictor of Myocardial Viability

Altun

Durmuş-Altun²,

Birsin³

et al. 2005

Cardiology

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We investigated whether spontaneous normalization of negative T waves (TWN) on infarct-related ECG leads (IRLs) in the chronic phase of Q wave anterior myocardial infarction (MI) could be a predictor of residual viability in infarct areas. We prospectively studied 35 patients (age 60 ± 8.6 years) in the chronic phase of Q wave anterior MI. Spontaneous TWN (group A, n = 23) were defined as negative T waves that became upright (≧0.15 mV) in ≧2 IRLs. The presence of negative T waves (group B, n = 12) was defined as symmetric or biphasic negative T wave of ≧0.15 mV. All patients underwent same-day rest ²⁰¹Tl-stress ^99mTc sestamibi dual-isotope myocardial perfusion SPECT and 24-hour ²⁰¹Tl reinjection imaging for ischemia and viability analysis. On scintigraphic examination, ischemic or viable myocardial segments were found in 18 patients (78%) with TWN and 4 patients (33%) of group B (p = 0.013). The use of TWN as a parameter had a marked influence on the sensitivity (82%), specificity (62%), positive (78%) and negative (67%) predictive values and accuracy (74%) of the diagnosis of viable myocardium. If we add the criterion of positive T waves in aVR with negative T waves to our criteria, we found that sensitivity (90%), positive (80%) and negative (80%) predictive values and accuracy (80%) increased. The results of our study suggest that analysis of TWN on IRLs is an accurate marker of residual viability and/or persistent peri-infarct ischemia in patients in the chronic stage of Q wave anterior MI, and therefore optimizes the diagnostic and therapeutic strategies after MI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Normalization of Negative T Waves in the Chronic Stage of Q Wave Anterior Myocardial Infarction as a Predictor of Myocardial Viability

Altun

Durmuş-Altun²,

Birsin³

et al. 2005

Cardiology

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“…13 In the chronic phase of infarction, patients with restored positive T waves who benefited from optimal revascularisation of the infarct related artery have better contractile reserve, shown with low dose dobutamine stress echocardiography, than those with negative T waves. 7 Few studies have compared patients with early versus delayed T wave normalisation. Only a recent study has shown that the earlier the negative T waves reverted to positive, the greater the improvement of left ventricular function, 11 but the myocardial state was not assessed by any imaging technique.…”

Section: T Wave Evolution and Left Ventricular Functionmentioning

confidence: 99%

Determinants of persistent negative T waves and early versus late T wave normalisation after acute myocardial infarction

Piérard

Lancellotti

2005

Heart

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Objective: To determine whether persistent versus early or delayed T wave normalisation of negative T waves after acute myocardial infarction is determined by the myocardial state, the treatment strategy, or both. Design: 127 consecutive patients with a first acute myocardial infarction and > 2 negative T waves on the 24-36 hour ECG were studied. They underwent dobutamine stress echocardiography and coronary angiography during the first week. ECG was recorded at hospital discharge and at a mean (SD) of 4 (1) months. Setting: University hospital. Results: T wave normalisation was observed in 88 patients (early at discharge in 19 and delayed at four months in 69). Early T wave normalisation was associated with sustained contractile reserve during dobutamine stress (13 of 19 (68%)), whereas delayed T wave normalisation was observed mainly in patients with an ischaemic response (49 of 69 (71%)). The persistence of negative T waves was associated with an ischaemic response (21 of 39 (54%)) or persistent akinesis (17 of 39 (44%)). Among patients with an ischaemic response to dobutamine, in-hospital elective angioplasty was an independent determinant of delayed T wave normalisation (39 of 49 v 4 of 21 patients with persistent negative T waves at four months, p , 0.0001). Conclusions: Early T wave normalisation is associated with dobutamine induced, sustained improvement indicating myocardial stunning. Delayed normalisation is observed mainly in patients with ischaemic myocardium who have undergone revascularisation. Persistent negative T waves correspond to either extensive necrosis or non-revascularised, jeopardised myocardium.T he clinical significance of negative T waves after acute myocardial infarction is controversial. Negative T waves early after thrombolysis are associated with patency of the infarct related artery, mild to moderate residual stenosis, and preserved left ventricular function [1][2][3] and are an independent predictor of one month survival. 4 In contrast, negative T waves were a predictor of death in long term studies analysing patients who survived three to four months after acute myocardial infarction. 6These contradictory observations probably relate to differing characteristics of persistent negative T waves as opposed to reversible negative T waves that normalise over time. Spontaneous normalisation of negative T waves is a marker of myocardial viability 7 8 and predicts recovery of regional dysfunction. 10Functional recovery is greater in the presence of early T wave normalisation. 11 Persistent negative T waves have been found to be associated with transmural necrosis.12 Accordingly, we hypothesised that persistent versus early or delayed normalisation of negative T waves after a first acute myocardial infarction are determined by the myocardial state, the treatment strategy, or both. METHODS Patient selectionThe study population consisted of 127 consecutive patients prospectively enrolled with the following inclusion criteria: diagnosis of acute myocardial infarction (typical chest pain >...

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Transient deep and giant negative T waves in dogs with myocardial injury

Romito

Cipone

2021

Journal of Veterinary Cardiology

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Viability of Q-wave infarcted myocardium with restored positive and persistent negative T waves after optimal revascularization compared with dobutamine stress echocardiography

Cited by 7 publications

References 13 publications

Normalization of Negative T Waves in the Chronic Stage of Q Wave Anterior Myocardial Infarction as a Predictor of Myocardial Viability

Normalization of Negative T Waves in the Chronic Stage of Q Wave Anterior Myocardial Infarction as a Predictor of Myocardial Viability

Determinants of persistent negative T waves and early versus late T wave normalisation after acute myocardial infarction

Transient deep and giant negative T waves in dogs with myocardial injury

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