Key result
Isolated non-specific ST-T abnormalities linked to ~4.9-fold higher odds of myocardial perfusion defects on SPECT.
Why the study?
Non-specific ST-T wave abnormalities are frequently encountered on resting ECG, yet their clinical relevance in terms of myocardial perfusion and left ventricular function remains debated.
Are isolated non-specific ST-T wave abnormalities on resting ECG associated with myocardial perfusion defects and left ventricular functional impairment on Gated-SPECT compared to a normal ECG?
Cross-Sectional (n=226)
Are isolated non-specific ST-T wave abnormalities on resting ECG associated with myocardial perfusion defects and left ventricular functional impairment on Gated-SPECT compared to a normal ECG?
Isolated non-specific ST-T wave abnormalities on resting ECG are independently associated with nearly five-fold higher odds of myocardial perfusion defects and lower left ventricular ejection fraction and peak filling rate on Gated-SPECT, supporting further non-invasive evaluation in symptomatic patients.
Answers are grounded in this paper and cite their sources.
May prompt targeted SPECT evaluation in symptomatic patients; extends ECG-perfusion links but remains hypothesis-generating.
INTRODUCTION: Non-specific ST-T (NST) wave abnormalities are frequently encountered on resting ECG, yet their clinical relevance remains debated. This study evaluated myocardial perfusion and left ventricular function using Gated-SPECT in patients with isolated NST abnormalities compared to those with normal ECGs. MATERIALS AND METHODS: In this cross-sectional study, 226 patients referred for MPI were enrolled (normal ECG: n = 113; isolated NST: n = 113). Patients with BBBs, ventricular pacing, pre-excitation, significant arrhythmias, and LVH with strain were excluded. Semiquantitative perfusion scores, defect extent, and Gated-SPECT functional parameters were assessed. Multivariable logistic and linear regressions were performed to adjust for cardiovascular risk factors. RESULTS: Typical chest pain was more prevalent in the normal ECG group (12.4% vs. 0.9%, p < 0.001), while atypical symptoms predominated in the NST group (75.2% vs.<4%, p < 0.001). Perfusion scores (SSS, SRS, SDS) and defect extent were significantly higher in the NST group (p < 0.001). Patients with NST changes demonstrated significantly lower LVEF (65.13 ± 12.67% vs. 70.72 ± 12.50%, p = 0.001) and lower PFR (2.52 ± 1.17 vs. 2.87 ± 1.10 EDV/s, p = 0.021). After multivariable adjustment, isolated NST changes independently predicted the presence of perfusion defects (SSS ≥ 4; OR = 4.87, 95% CI: 2.58-9.21, p < 0.001) and higher SSS (β = 3.12, 95% CI: 2.04-4.20, p < 0.001). DISCUSSION: Patients with isolated non-specific ECG changes showed worse perfusion abnormalities and lower PFR, while ventricular functional indices remained largely unchanged. CONCLUSION: Isolated NST abnormalities are independently associated with myocardial perfusion defects and subtle left ventricular functional impairment. In symptomatic patients, NST changes should prompt further non-invasive evaluation, where Gated-SPECT serves as an effective risk-stratification tool.
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Jalali-Zefrei et al. (2026) conducted a cross-sectional in Isolated non-specific ST-T wave abnormalities referred for myocardial perfusion imaging (n=226). Isolated non-specific ST-T (NST) wave abnormalities on resting ECG vs. Normal resting ECG was evaluated on Presence of myocardial perfusion defects (SSS ≥ 4) on Gated-SPECT (OR 4.87, 95% CI 2.58-9.21, p=<0.001). Isolated non-specific ST-T wave abnormalities independently predicted myocardial perfusion defects on Gated-SPECT (OR 4.87; 95% CI 2.58-9.21; p<0.001).
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