DIFFERENTIATION OF MYOCARDIAL ISCHEMIA AND LEFT VENTRICULAR ANEURYSM IN THE GENESIS OF EXERCISE-INDUCED ST-T CHANGES IN PREVIOUS ANTERIOR MYOCARDIAL INFARCTION
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概要
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We attempted to differentiate between myocardial ischemia and left ventricular asynergy as the underlying mechanisms of exercise-induced ST-segment elevation in patients with previous myocardial infarction (MI). sixty patients with previous anterior MI, who underwent stress myocardial scintigraphy (SMS) and coronary angiography (CAG), which revealed a single vessel disease of the left anterior descending artery, were entered in this study. SMS and CAG were performed within 3 months of MI onset, and SMS and ECG were quantitatively analyzed. T wave changes to a complete upright position with concomitant ST-segment elevation (T-dominant ST-elevation) was seen in 56% of the patients with post-MI angina pectoris (N=16) and in 50% of those with significant redistribution in SMS (n=20). On the other hand, ST-segment elevation without T wave reversion (ST-dominant ST-elevation) was seen in 43% of patients with severe LV asynergy (akinesis and dyskinesis, n=39) and in 50% of those with severe scintigraphic defect in delayed images (relative thallium uptake ⩽40%, n=10). When these findings were combined, T-dominant ST-elevation had sensitivity and specificity of 54% and 78%, respectively, for the diagnosis of myocardial ischemia, while the corresponding values for ST-dominant ST-elevation were 44% and 100%, for the diagnosis of severe ventricular asynergy. We conclude that the two underlying mechanisms, ischemia and asynergy, may produce different changes in ST-T shape in patients with previous myocardial infarction.
- 社団法人日本循環器学会の論文
- 1987-05-20
著者
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Saito Muneyasu
The Heart Institute Of Japan Tokyo Women's Medical University
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林田 孝平
国立循環器病センター研究所
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Fukami Kenichi
Division Of Cardiology Iwate Medical College
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Haze Kazuo
Department Of Cardiology National Cardiovascular Center
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Nishimura Tsunehiko
Radiology
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Fukami Kenichi
Department of Internal Medicine, National Cardiovascular Center
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Hiramori Katsuhiko
Department Of Cardiology Iwate Medical University
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Uehara Toshiisa
Radiology, National Cardiovascular Center
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Fukami Kenichi
Iwate Medical University
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Saito Muneyasu
Department Of Cardiology The Heart Institute Of Japan Tokyo Women's Medical University
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Fakami Kenichi
Cardiac Division Department Of Internal Medicine National Cardiovascular Center
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Tomita Masaaki
Department Of Cardiology Gifu Prefectural Hospital
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Tomita Masaaki
Department Of Internal Medicine
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Asonuma Hirohiko
Department of Circulatory Organs, Okayama Red Cross General Hospital
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Sumiyoshi Tetsuya
Department Of Cardiology Heart Institute Of Japan Tokyo Women's Medical College
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HAYASHIDA KOUHEI
Radiology,National Cardiovascular Center
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Asonuma Hirohiko
Department Of Circulatory Organs Okayama Red Cross General Hospital
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Asonuma Hirohiko
Department Of Internal Medicine
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