<Review>A mechanism and clinical implications of exercise-induced ST-segment elevation in patients recovering from myocardial infarction

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概要

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• Background Exercise-induced ST-segment elevation is not uncommon in patients after myocardial infarction. Concerning the mechanism, myocardial ischemia and wall motion abnormality have been discussed for two decades but both are highly controversial. We are proposing a novel mechanism that the ST elevation may result from an enhanced β-adrenergic activity in peri-infarct and noninfarct areas. Methods The patients with prior myocardial infarction underwent exercise tests and isoproterenol infusion while the electrocardiograms, hemodynamics and left ventricular wall motion were measured. To investigate experimentally the mechanism of the ST elevation during the interventions such as catecholamine infusions and treadmill exercise, we measured regional myocardial blood flow and wall motion abnormalities and electrocardiographic changes using a canine model of myocardial infarction produced by LAD embolization. Long-term prognosis after myocardial infarction was surveyed in relation to exercise-induced ST-segment shifts. Results The patients with ST elevation achieved higher exercise levels associated with augmented sympathetic activity than the other patient groups. Isoproterenol infusion induced a distinct ST-segment elevation which is quite similar to that induced by exercise in both the patient and canine models without myocardial ischemia and aggravation of wall motion abnormality. Regional myocardial blood flow and wall motion in the peri-infarct region were enhanced by isoproterenol and exercise. The survival rate and follow-up cardiac events were better in patients with ST elevation than in those with ST depression. Conclusions ST-segment elevation was induced without myocardial ischemia and aggravation of wall motion abnormality by both infusion of isoproterenol and exercise in the canine model and patients with myocardial infarction. It is concluded that enhanced β-adrenergic activity can cause ST-segment elevation.

• 近畿大学の論文

著者

• Yamamoto Toshio

  Life Science Institute Kinki University School Of Medicine

• KATORI Ryo

  First Dept. of Inter. Med Tohoku Univ. School of Med.

• Yamashita Keizo

  First Department Of Internal Medicine Kinki University School Of Medicine

• MIYAZAKI Toshio

  First Department of Internal Medicine, Kinki University School of Medicine

• INOKI Tatsu

  First Department of Internal Medicine, Kinki University School of Medicine

• YAMAMOTO Tadahiko

  First Department of Internal Medicine, Kinki University School of Medicine

• SHIBUTANI Toshiyuki

  First Department of Internal Medicine, Kinki University School of Medicine

• HIOKI Junya

  First Department of Internal Medicine, Kinki University School of Medicine

• Miyazaki Toshio

  The First Department Of Medicine Kinki University School Of Medicine

• Katori Ryo

  Showa Hosptial

• Inoki Tatsu

  First Department Of Internal Medicine Kinki University School Of Medicine

• Shibutani Toshiyuki

  The First Department Of Medicine Kinki University School Of Medicine

• Miyazaki Toshio

  First Department Of Internal Medicine Kinki University School Of Medicine

• Yamamoto Toshio

  First Department Of Internal Medicine Kinki University School Of Medicine

• Katori Ryo

  First Department Of Internal Medicine Kinki University School Of Medicine

• Katori R

  Showa Hosptial

• Hioki Junya

  First Department Of Internal Medicine Kinki University School Of Medicine

• Tashi Masahiro

  First Department Of Internal Medicine Kinki University School Of Medicine

• Tashi Masahiro

  The First Department Of Medicine Kinki University School Of Medicine

• Yamamoto Tadahiko

  First Department Of Internal Medicine Kinki University School Of Medicine

• Yamamoto Tadahiko

  The First Department Of Medicine Kinki University School Of Medicine

• Katori Ryo

  Ist Div. Dept. Of Intern. Med. (prof. T Nakamura) Tohoku University School Of Med. Sendai

• Katori Ryo

  Nakamura Clinic Tohoku University

• Katori Ryo

  The First Department Of Internal Medicine Kinki University School Of Medicine Osaka

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