Abstract
Objective:
To determine if T‐wave normalization during exercise or dobutamine stress testing identified patients with myocardial ischemia as indicated by reversible perfusion defects.
Methods:
Exercise or dobutamine stress tests with perfusion scintigraphy were performed in 1,173 patients with abnormal T‐waves on their baseline electrocardiograms. The results of perfusion scintigraphy were compared in patients with and without stress‐induced T‐wave normalization.
Results:
Only 33 of 270 patients with reversible perfusion defects (12.2%) had T‐wave normalization during stress while 76.4% of 140 patients who had T‐wave normalization during stress did not have a reversible perfusion defect. Results were similar for patients who did or did not reach 85% of their maximal predicted heart rate, for patients with and without Q‐wave infarction on the baseline EKG and for patients who did or did not have ischemic ST‐segment depression during stress.
Conclusions:
T‐wave normalization during stress testing has low sensitivity and poor positive predictive value for stress‐induced reversible myocardial ischemia. Copyright © 2007 Wiley Periodicals, Inc.
Keywords: T‐wave normalization, exercise testing, perfusion scintigraphy, dobutamine stress, reversible ischemia
Full Text
The Full Text of this article is available as a PDF (2.7 MB).
References
- 1. Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF, et al.: A report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee to Update the 1997 Exercise Testing Guidelines). J Am Coll Cardiol 2002; 440: 1531–1540. [DOI] [PubMed] [Google Scholar]
- 2. Noble RJ, Rothbaum DA, Knoebel SB, McHenry PL, Anderson GJ: Normalization of abnormal T waves in ischemia. Arch Intern Med 1976; 136: 391–395. [PubMed] [Google Scholar]
- 3. Surawicz B, Saito S: Exercise testing for detection of myocardial ischemia in patients with abnormal electrocardiograms at rest. Am J Cardiol 1978; 41: 943–951. [DOI] [PubMed] [Google Scholar]
- 4. Daoud FS, Surawicz B, Gettes LS: Effect of isoproterenol on the abnormal T wave. Am J Cardiol 1972; 30: 810–819. [DOI] [PubMed] [Google Scholar]
- 5. Nagase K, Tamura A, Mikuriya Y, Nasu M: Spontaneous normalization of negative T waves in infarct related leads reflects improvement in left ventricular wall motion even in patients with persistent abnormal Q waves after anterior wall acute myocardial infarction. Cardiology 2001; 96: 94–99. [DOI] [PubMed] [Google Scholar]
- 6. Altun A, Durmus‐Altun G, Birsin A, Gultekin A, Tatli E, et al.: Normalization of negative T waves in the chronic stage of Q wave anterior myocardial infarction as a predictor of myocardial viability. Cardiology 2005; 103: 73–78. [DOI] [PubMed] [Google Scholar]
- 7. Marin JJ, Heng MK, Sevrin R, Udhoji VN: Significance of T wave normalization in the electrocardiogram during exercise stress test. Am Heart J 1987; 114: 1342–1348. [DOI] [PubMed] [Google Scholar]
- 8. Ajisaka R, Watanabe S, Masuoka T, Yamanouchi T, Saitoh T, et al.: Relationship between normalization of negative T waves on exercise EKG and residual myocardial viability in patients with previous myocardial infarction and no post infarction angina. Jpn Circ J 1998; 62: 153–159. [DOI] [PubMed] [Google Scholar]
- 9. Pizzetti G, Montorfano M, Belotti G, Margonato A, Ballarotto C, et al.: Exercise‐induced T‐wave normalization predicts recovery of regional contractile function after anterior myocardial infarction. Eur Heart J 1998; 19: 420–428. [DOI] [PubMed] [Google Scholar]
- 10. Giorgetti A, Sambuceti G, Neglia D, Sorace O, Salvadori PA, et al.: Significance of both negative T waves and stress‐induced normalization of the repolarization phase in infarcted patients: a positron‐emission‐tomography assessment of regulation of myocardial blood flow and viability of myocardium. Coron Artery Dis 2001; 12: 205–215. [DOI] [PubMed] [Google Scholar]
- 11. Mobilia G, Zanco P, Desideri A, Neri G, Alitto F, et al.: T‐wave normalization in infarct‐related electrocardiographic leads during exercise testing for detection of residual viability: comparison with positron emission tomography. J Am Coll Cardiol 1998; 32: 75–82. [DOI] [PubMed] [Google Scholar]
- 12. Elhendy A, Geleijnse L, Salustri A, van Domburg RT, Cornel JH, et al.: T wave normalization during dobutamine stress testing in patients with non‐Q wave myocardial infarction. A marker of myocardial ischemia? Eur Heart J 1996; 17: 526–531. [DOI] [PubMed] [Google Scholar]
- 13. Hahalis G, Stathopoulos C, Apostolopoulos D, Vasilakos P, Alexopoulos D, et al.: Contribution of the sST elevation /T‐wave normalization in Q‐wave leads during routine, pre‐discharge treadmill exercise test to patient management and risk stratification after acute myocardial infarction: a 2.5‐year follow‐up study. J Am Coll Cardiol 2002; 40: 62–70. [DOI] [PubMed] [Google Scholar]
- 14. Kim KJ, Shim WJ, Jung SW, Pak HN, Lee SJ, et al.: Relationship between T‐wave normalization on exercise ECG and myocardial functional recovery in patients with acute myocardial infarction. Korean J Intern Med 2002; 17: 122–130. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15. Ho YL, Lin LC, Yen RF, Wu CC, Chen MF, et al.: Significance of dobutamine‐induced ST‐segment elevation and T‐wave pseudonormalization in patients with Q‐wave myocardial infarction: simultaneous evaluation by dobutamine stress echocardiography and thallium‐201 SPECT. Am J Cardiol 1999; 84: 125–129. [DOI] [PubMed] [Google Scholar]
- 16. Rambaldi R, Bigi R, Desideri A, Curti G, Occhi G: Prognostic usefulness of dobutamine‐induced ST‐segment elevation and T wave normalization after uncomplicated acute myocardial infarction. Am J Cardiol 2000; 86: 786–789. [DOI] [PubMed] [Google Scholar]
- 17. Bednarz B, Wolk R, Mazurek T, Stec S, Chamiec T: Event‐free survival in patients after an acute coronary event with exercise‐induced normalization of the T‐wave. Clin Cardiol 2001; 24: 564–569. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18. Frais MA, Hoeschen RJ: Exercise‐induced T wave normalization is not specific for myocardial ischemia detected by perfusion scintigraphy. Am Heart J 1990; 119: 1225–1229. [DOI] [PubMed] [Google Scholar]