<Originals>Increased regional myocardial blood flow in peri-infarct area during exercise-induced ST-segment elevation in canine myocardial infarction

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To examine the mechanism of exercise-induced ST-segment elevation in post myocardial infarction, we used a canine model of transmural myocardial infarction and measured regional myocardial blood flow with microspheres during exercise. Anterior myocardial infarction was created by embolization with a gelatin sponge in 9 dogs. The treadmill exercise tests on the fifth day after infarction caused a significant increase in the sum of ST-segment elevation in leads V2,V3,and V4 from 0.28±0.20 (mean±SD) to 0.60±0.23 mV (p<0.01). Myocardial blood flow increased significantly in the peri-infarct area (endocardial layer 0.36±0.34 to 0.77±0.66 ml/min/g, p<0.01,epicardial layer 0.52±0.24 to 1.02±0.55ml/min/g, p< 0.01). The endo/epi ratio remained at (0.65±0.37 to 0.67±0.49,ns). Coagulation necrosis extended to the epicardium. Myocardial blood flow in the infarcted area was limited, and did not change during exercise. We conclude that exercise-induced ST-segment elevation does not result from myocardial ischemia adjacent to the infarct area. The increase of myocardial blood flow suggests the enhancement of wall motion in the peri-infarct area during exercise.
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