Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1981 Jul;46(1):84–92. doi: 10.1136/hrt.46.1.84

Clinical significance of exercise-induced ST segment elevation. Correlative angiographic study in patients with ischaemic heart disease.

P J de Feyter, P A Majid, M J van Eenige, R Wardeh, F N Wempe, J P Roos
PMCID: PMC482607  PMID: 7272118

Abstract

We have examined the relation between electrocardiographic ST elevation during treadmill exercise (greater than or equal to 1 mm, using the conventional 12 leads), the severity of coronary artery disease, and left ventricular wall motion abnormalities in 680 patients. They were divided into three groups: (1) 218 patients with clinically significant coronary artery disease, (2) 178 patients with clinically significant coronary artery disease, and (3) 284 patients with clinically significant coronary artery disease and previous myocardial infarction. ST elevation during exercise (predominantly in lead V2) was seen in two patients (1%) in group 1, three patients (2%) in group 2, and 147 patients (52%) in group 3. Coronary artery disease (number of vessels involved and severity of stenoses) was comparable in groups 2 and 3. All the patients in group 1 showed a normal left ventricular contraction pattern; 64% of the patients in group 2 showed wall motion abnormalities (predominantly hypokinesia) and 95% of group 3 (mainly akinesia, dyskinesia, or aneurysm). A strongly positive correlation was seen between the ST elevation and left ventricular dysfunction in patients belonging to group 3. The overall sensitivity and the specificity of the stress test in detecting wall motion abnormalities was 55% and 100% respectively. The sensitivity increased with deterioration in left ventricular function, reaching 81% and 90% in patients with dyskinesia and aneurysm, respectively. Maximal ST elevation (greater than or equal to 3 mm) was confined to the patients with dyskinesia or aneurysm. The incidence of ST elevation during exercise was also related to the location of previous infarction, showing a positive response in 85% of patients with anterior myocardial infarction and in only 33% with inferior myocardial infarction. We conclude that ST segment elevation during exercise in patients with previous myocardial infarction is a sensitive and a specific indicator of advanced left ventricular asynergy. The ST segment response during exercise in patients with previous infarction and with angiographically demonstrated myocardial asynergy appears to be a continuous spectrum. A normal ST segment response or elevation alone usually signifies involvement of only one vessel supplying the infarcted myocardium, ST elevation with concomitant ST depression indicates additional coronary artery disease, and ST depression alone indicates overwhelming myocardial ischaemia resulting from multiple vessel disease. The employment of multiple leads is essential to obtain this information.

Full text

PDF
84

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Atterhög J. H., Ekelund L. G., Kaijser L. Electrocardiographic abnormalities during exercise 3 weeks to 18 months after anterior myocardial infarction. Br Heart J. 1971 Nov;33(6):871–877. doi: 10.1136/hrt.33.6.871. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. BRUCE R. A., BLACKMON J. R., JONES J. W., STRAIT G. EXERCISING TESTING IN ADULT NORMAL SUBJECTS AND CARDIAC PATIENTS. Pediatrics. 1963 Oct;32:SUPPL–756. [PubMed] [Google Scholar]
  3. Bobba P., Vecchio C., Di Guglielmo L., Salerno J., Casari A., Montemartini C. Exercise-induced RS-T elevation. Electrocardiographic and angiographic observations. Cardiology. 1972;57(3):162–171. doi: 10.1159/000169514. [DOI] [PubMed] [Google Scholar]
  4. Bruce R. A. Exercise testing for evaluation of ventricular function. N Engl J Med. 1977 Mar 24;296(12):671–675. doi: 10.1056/NEJM197703242961206. [DOI] [PubMed] [Google Scholar]
  5. Bruce R. A., Hornsten T. R. Exercise stress testing in evaluation of patients with ischemic heart disease. Prog Cardiovasc Dis. 1969 Mar;11(5):371–390. doi: 10.1016/0033-0620(69)90027-9. [DOI] [PubMed] [Google Scholar]
  6. Chahine R. A., Raizner A. E., Ishimori T. The clinical significance of exercise-induced ST-segment elevation. Circulation. 1976 Aug;54(2):209–213. doi: 10.1161/01.cir.54.2.209. [DOI] [PubMed] [Google Scholar]
  7. Dubnow M. H., Burchell H. B., Titus J. L. Postinfarction ventricular aneurysm. A clinicomorphologic and electrocardiographic study of 80 cases. Am Heart J. 1965 Dec;70(6):753–760. doi: 10.1016/0002-8703(65)90331-5. [DOI] [PubMed] [Google Scholar]
  8. Ellestad M. H., Cooke B. M., Jr, Greenberg P. S. Stress testing: clinical application and predictive capacity. Prog Cardiovasc Dis. 1979 May-Jun;21(6):431–460. doi: 10.1016/0033-0620(79)90025-2. [DOI] [PubMed] [Google Scholar]
  9. FORD R. V., LEVINE H. D. The electrocardiographic clue to ventricular aneurysm. Ann Intern Med. 1951 Apr;34(4):998–1016. doi: 10.7326/0003-4819-34-4-998. [DOI] [PubMed] [Google Scholar]
  10. Faris J. V., McHenry P. L., Morris S. N. Concepts and applications of treadmill exercise testing and the exercise electrocardiogram. Am Heart J. 1978 Jan;95(1):102–114. doi: 10.1016/0002-8703(78)90403-9. [DOI] [PubMed] [Google Scholar]
  11. Fortuin N. J., Friesinger G. C. Exercise-induced S-T segment elevation. Clinical, electrocardiographic and arteriographic studies in twelve patients. Am J Med. 1970 Oct;49(4):459–464. doi: 10.1016/s0002-9343(70)80039-0. [DOI] [PubMed] [Google Scholar]
  12. Fortuin N. J., Weiss J. L. Exercise stress testing. Circulation. 1977 Nov;56(5):699–712. doi: 10.1161/01.cir.56.5.699. [DOI] [PubMed] [Google Scholar]
  13. Gorlin R., Klein M. D., Sullivan J. M. Prospective correlative study of ventricular aneurysm. Mechanistic concept and clinical recognition. Am J Med. 1967 Apr;42(4):512–531. doi: 10.1016/0002-9343(67)90051-4. [DOI] [PubMed] [Google Scholar]
  14. Haïat R., Broustet J. P. L'électrocardiogramme d'effort après la phase aiguë de l'infarctus du myocarde. Analyse de 100 cas. Nouv Presse Med. 1976 Mar 20;5(12):775–778. [PubMed] [Google Scholar]
  15. Hegge F. N., Tuna N., Burchell H. B. Coronary arteriographic findings in patients with axis shifts or S-T-segment elevations on exercise-stress testing. Am Heart J. 1973 Nov;86(5):603–615. doi: 10.1016/0002-8703(73)90337-2. [DOI] [PubMed] [Google Scholar]
  16. Lester M., Sheffield L. T., Trammell P., Reeves T. J. The effect of age and athletic training on the maximal heart rate during muscular exercise. Am Heart J. 1968 Sep;76(3):370–376. doi: 10.1016/0002-8703(68)90233-0. [DOI] [PubMed] [Google Scholar]
  17. Longhurst J. C., Kraus W. L. Exercise-induced ST elevation in patients without myocardial infarction. Circulation. 1979 Sep;60(3):616–629. doi: 10.1161/01.cir.60.3.616. [DOI] [PubMed] [Google Scholar]
  18. Mills R. M., Jr, Young E., Gorlin R., Lesch M. Natural history of S-T segment elevation after acute myocardial infarction. Am J Cardiol. 1975 May;35(5):609–614. doi: 10.1016/0002-9149(75)90045-4. [DOI] [PubMed] [Google Scholar]
  19. Mourdjinis A., Olsen E., Raphael M. J., Mounsey J. P. Clinical diagnosis and prognosis of ventricular aneurysm. Br Heart J. 1968 Jul;30(4):497–513. doi: 10.1136/hrt.30.4.497. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Paine T. D., Dye L. E., Roitman D. I., Sheffield L. T., Rackley C. E., Russell R. O., Jr, Rogers W. J. Relation of graded exercise test findings after myocardial infarction to extent of coronary artery disease and left ventricular dysfunction. Am J Cardiol. 1978 Nov;42(5):716–723. doi: 10.1016/0002-9149(78)90089-9. [DOI] [PubMed] [Google Scholar]
  21. STEVEN R. A. Electrocardiographic findings in cardiac aneurysm. Ann Intern Med. 1951 Mar;34(3):747–758. doi: 10.7326/0003-4819-34-3-747. [DOI] [PubMed] [Google Scholar]
  22. Sheffield L. T., Roitman D. Stress testing methodology. Prog Cardiovasc Dis. 1976 Jul-Aug;19(1):33–49. doi: 10.1016/0033-0620(76)90007-4. [DOI] [PubMed] [Google Scholar]
  23. Specchia G., de Servi S., Falcone C., Bramucci E., Angoli L., Mussini A., Marinoni G. P., Montemartini C., Bobba P. Coronary arterial spasm as a cause of exercise-induced ST-segment elevation in patients with variant angina. Circulation. 1979 May;59(5):948–954. doi: 10.1161/01.cir.59.5.948. [DOI] [PubMed] [Google Scholar]
  24. Waters D. D., Chaitman B. R., Dupras G., Théroux P., Mizgala H. F. Coronary artery spasm during exercise in patients with variant angina. Circulation. 1979 Mar;59(3):580–585. doi: 10.1161/01.cir.59.3.580. [DOI] [PubMed] [Google Scholar]
  25. Weiner D. A., McCabe C., Klein M. D., Ryan T. J. ST segment changes post-infarction: predictive value for multivessel coronary disease and left ventricular aneurysm. Circulation. 1978 Nov;58(5):887–891. doi: 10.1161/01.cir.58.5.887. [DOI] [PubMed] [Google Scholar]
  26. Yasue H., Omote S., Takizawa A., Nagao M., Miwa K., Tanaka S. Circadian variation of exercise capacity in patients with Prinzmetal's variant angina: role of exercise-induced coronary arterial spasm. Circulation. 1979 May;59(5):938–948. doi: 10.1161/01.cir.59.5.938. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES