An Electrocardiographic, Anatomic, and Metabolic Study of Zonal Myocardial Ischemia in Coronary Heart Disease

An integrated approach, utilizing cine coronary angiography, the standard 12-lead and post-exercise electrocardiograms, and regional myocardial lactate metabolism, is presented for detection of regional myocardial ischemia in patients with coronary heart disease. The normal electrocardiogram was of no predictive value and was present with extensive coronary disease and myocardial production of lactate. The abnormal electrocardiogram gave an accurate indication of a portion, but not all zones of ischemia. Multiple electrocardiographic abnormalities were invariably associated with severe coronary artery disease, although in most patients many more coronary lesions were present than electrocardiographic abnormalities. The regional lactate pattern was very helpful in localizing myocardial ischemia and significant coronary artery lesions. Regional lactate abnormalities may have a great practical value in the selection of patients for myocardial revascularization surgery and in their postoperative evaluation.