A Predictor of Positive Drug Provocation Testing in Individuals With Saddle-Back Type ST-Segment Elevation

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Background: A drug provocation test is performed to unmask a type 1 electrocardiogram (ECG) in individuals with saddle-back type ST-segment elevation in the right precordial leads (SB-ECG). The study investigated predictors of positive responders (PR) by drug testing. Methods and Results: A total of 58 consecutive individuals with SB-ECG in lead V2 were enrolled and drug testing was performed. In leads V2 at standard and the third intercostal space (V2IC3), the QRS duration was measured, the amplitudes of r wave (r), ST-segment 20 and 40 ms after the r wave (r20 and r40, respectively), the bottom of the ST-segment (STb), the differences between r and r20 (r-r20), r and r40 (r-r40), r and STb (r-STb), and the descending rate of the ST-segment [(r-r20)/r; DR20, (r-r20)/(r-STb); DR20-STb] were also measured. Thirty-five PR had significantly longer QRS duration, larger r20 and r40, and smaller r-r20, DR20, and DR20-STb than negative responders. DR20 and DR20-STb in leads V2 and V2IC3 were most significantly different between 2 groups. The positive and negative predictive values of `DR20-STb in lead V2IC3 <0.62 for prediction of positive tests were 92.3% and 81.8%, respectively. Conclusions: In individuals with SB-ECG, DR20 and DR20-STb in leads V2 and V2IC3 might be useful predictors of positive testing.
2009-09-20