Key result
ST-segment depression on 12-lead exercise electrocardiography accurately predicted the site of myocardial ischemia in anginal patients with single-vessel territory ischemia when ST-segment depression developed in a single lead group (p < 0.01).
Why the study?
Does the location of ST-segment depression on exercise electrocardiography predict the area of myocardial ischemia on 99mTc-MIBI scanning in anginal patients?
Cross-Sectional (n=48)
No
Does the location of ST-segment depression on exercise electrocardiography predict the area of myocardial ischemia on 99mTc-MIBI scanning in anginal patients?
p-value: p=<0.01
ST-segment depression in a single lead group on exercise ECG is a reliable predictor of the site of myocardial ischemia in patients with single-vessel territory ischemia, provided the apical area is not involved.
ST-segment depression in a single lead group may localize ischemia in single-vessel angina; leaves open prospective validation before practice change.
Background：The purpose of the study was to determine the value of exercise electrocardiography in predicting the area of myocardial ischemia.Method：Seventy-six anginal patients with a perfusion defect in one vessel territory on exercise 99m Tc-MIBI myocardial perfusion scan were studied.Each patient underwent exercise electrocardiograhy using modified Bruce protocol.Exercise electrocardiography was interpreted as abnormal when the horizontal or downsloping depression in ST segment was 0.1 mV or greater at 80 msec after the J point during exercise.Forty-eight patients had exercise induced ST-segment depression.Result： Twenty-five patients had exercise induced ST-segment depression in single lead-group and 23 patients had in multiple lead-groups.In 18 patients (18/23) with exercise induced ST-segment depression in multiple leadgroups, the perfusion defect involved the apical area on myocardial perfusion scanning and in 21 patients (21/25) with ST-segment depression in single lead-group, the perfusion defect did not involve the apical area.In patients without perfusion defect in the apical area, ST-segment depression in anterior lead-group (V 1 to V 4 ) was associated with myocadial perfusion defects in left anterior descending artery territories in five of five cases (100%), ST-segment depression in lateral lead-group (I, aVL, V 5 , V 6 ) was associated with defects in left circumflex artery territories in six of six cases (100%), and ST-segment depression in inferior lead group (Ⅱ, Ⅲ, aVF) was associated with defects in right coronary artery territories in nine of ten (90%) (p<0.01).In patients with perfusion defect in the apical area, exercise induced ST-segment depressions were observed in multiple lead-groups (18/22).Conclusion：ST-segment depression on 12 lead exercise electrocardiography was a good predictor of the site of myocadial ischemia in anginal patients with single vessel territory ischemia when ST-segment depression developed in single lead group.However, ST-segment depressions in mutiple lead-groups suggested that the perfusion defect involved the apical area and did not predict the site of myocardial ischemia.( ( ( (Korean Circulation J 1998 ; 28( ( ( (4) ) ) ) : 676-682) ) ) )
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Kim et al. (1998) conducted a cross-sectional in Angina Pectoris (n=48). Exercise electrocardiography vs. 99mTc-MIBI Myocardial Perfusion Scanning was evaluated on Agreement between ST-segment depression lead groups and myocardial perfusion defect territories (p=<0.01). ST-segment depression on 12-lead exercise electrocardiography accurately predicted the site of myocardial ischemia in anginal patients with single-vessel territory ischemia when ST-segment depression developed in a single lead group (p < 0.01).
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