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Annals of Noninvasive Electrocardiology logoLink to Annals of Noninvasive Electrocardiology
. 2006 Oct 27;7(1):53–59. doi: 10.1111/j.1542-474X.2001.tb00139.x

QT Dispersion and Viable Myocardium in Patients with Prior Myocardial Infarction and Severe Left Ventricular Dysfunction

Vuy Hun Li 1, Sharmila Dorbala 1, Dhiraj Narula 1, Gordon DePuey 2, Jonathan S Steinberg 2,
PMCID: PMC7027710  PMID: 11844292

Abstract

Background: QT dispersion (QTd) has been found to correlate to the amount of viable myocardium in patients with Q‐wave myocardial infarction and well‐preserved LV function. However, this relationship is unknown in patients with severe left ventricular dysfunction.

Methods: Thirty‐four patients with prior large myocardial infarction and severe left ventricular dysfunction underwent Tc‐99m sestamibi single photon emission cardiac tomography (SPECT) and F‐18 fluorodeoxyglucose (FDG) SPECT. Viability was defined as a defect relative count density (DCD) of at least 20% greater on FDG SPECT. QTd, corrected QT dispersion (QTcd), and QT coefficient of variation (cv) in patients with viable myocardium was compared to those without viable mvocardium in the infarct area.

Results: Thirteen patients were excluded from analysis for poor FDG images or inadequate ECG tracings. Of the remaining patients, 10 (48%) were found to have viability on FDG SPECT. QTd, QTcd, and QTcv in patients with viability were: 58 ± 22 ms, 61 ± 23 ms, and 4.81 ± 1.76%, respectively, which did not differ significantly from those in patients without viability (QTd = 56 ± 14 ms, QTcd = 70 ± 16 ms and Qtcv = 5.06 ± 1.20% (P = NS]). Moreover, neither FDG defect size, nor LVEF correlated with QTd.

Conclusions: This study indicates no relationship between QTd and viability in patients with myocardial infarction and severe left ventricular dysfunction. A.N.E. 2002;7(1):53–59

Keywords: QT dispersion (QTd), FDG SPECT, myocardial viability, left ventricular dysfunction

REFERENCES

  • 1. Day CP, McComb JM, Campbell RWF. QT dispersion: An indication of arrhythmia risk in patients with long QT intervals. Br Heart J 1990;63:342–344. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2. Van de Loo A, Arendts W, Hohnloser SH. Variability of QT dispersion measurements in the surface ECG in patients with acute myocardial infarction and in normal subjects. Am J Cardiol 1994;74:1113–1118. [DOI] [PubMed] [Google Scholar]
  • 3. Bogun F, Chan KK, Harvey M, et al. QT dispersion in nonsustained ventricular tachycardia and coronary artery disease. Am J Cardiol 1996;77:256–259. [DOI] [PubMed] [Google Scholar]
  • 4. Pinsky DJ, Sciacca RR, Steinberg JS. QT dispersion as a marker of risk in patients awaiting heart transplantation. J Am Coll Cardiol 1997;29:1576–1584. [DOI] [PubMed] [Google Scholar]
  • 5. Miorelli M, Buja G, Melacini P, et al. QT interval variability in hypertrophic cardiomyopathy patients with cardiac arrest. Int J Cardiol 1994;45:121–127. [DOI] [PubMed] [Google Scholar]
  • 6. Zaputovic L, Mavric Z, Zaninovic‐Jurjevic T, et al. Relationship between QT dispersion and the incidence of early ventricular arrhythmias in patients with acute myocardial infarction. Int J Cardiol 1997;62: 211–216. [DOI] [PubMed] [Google Scholar]
  • 7. Perkiosmaki JS, Koistinen MJ, Yli‐Mayry S. et al. Dispersion of QT interval in patients with and without susceptibility to ventricular tachyarrhythmias after previous myocardial infarction. J Am Coll Cardiol 1995;26:174–179. [DOI] [PubMed] [Google Scholar]
  • 8. Higham PD, Furniss SS, Campbell RWF. QT dispersion and components of QT interval in ischaemia and infarction. Br Heart J 1995;73:32–36. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9. Perkiomaki JS, Huikuri HV, Koistinen JM, et al. Heart rate variability and dispersion of QT interval in patients with vulnerability to ventricular tachycardia and ventricular fibrillation after previous myocardial infarction. J Am Coll Cardiol 1997;30:1331–1338. [DOI] [PubMed] [Google Scholar]
  • 10. Pye M, Quinn AC, Cobbe SM. QT interval dispersion: A noninvasive marker of susceptibility to arrhythmia in patients with sustained ventricular arrhythmia Br Heart J 1994;71:511–514. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11. Moreno FL, Villanueva T, Karagounis LA, et al. Reduction in QT interval dispersion by successful thrombolytic therapy in acute myocardial infarction. Circulation 1994;90:94–100. [DOI] [PubMed] [Google Scholar]
  • 12. Sporton SC, Taggart P, Sutton PM, et al. Acute ischemia: A dynamic influence on QT dispersion. Lancet 1997;349:306–309. [DOI] [PubMed] [Google Scholar]
  • 13. Lowe MD. Rowland E, Grace AA. QT dispersion and triple‐vessel coronary disease. Lancet 1997;349:1175 (letter). [DOI] [PubMed] [Google Scholar]
  • 14. Struthers AD, Davidson NC, Naas A, et al. QT dispersion and triple vessel coronary disease. Lancet 1997;349:1174 (letter). [DOI] [PubMed] [Google Scholar]
  • 15. Faber TS, Zehender M, Krahnefeld O, et al. Propafenone during acute myocardial ischemia in patients: A double‐blind, randomized, placebo‐controlled study. J Am Coll Cardiol 1997;29:561–567. [DOI] [PubMed] [Google Scholar]
  • 16. Lee HS, Cross SJ, Rawles J, et al. QTc dispersion in patients with coronary artery disease. Effect of exercise, dobut‐amine and dipyridamole myocardial stress. Eur Heart J 1993;14:210–211 (Abstract). [Google Scholar]
  • 17. Roukema G, Singh JP, Meijs M, et al. Effect of exercise‐induced ischemia on QT interval dispersion. Am Heart J 1998;135: 88–92. [DOI] [PubMed] [Google Scholar]
  • 18. Musha H, So T, Hashimoto N, et al. Dynamic changes of QT dispersion as a predictor of myocardial ischemia on exercise testing in patients with angina pectoris. Jpn Heart J 1999;40:119–126. [DOI] [PubMed] [Google Scholar]
  • 19. Yunus A, Gillis AM, Traboulsi M, et al. Effect of coronary angioplasty on precordial QT dispersion. Am J Cardiol 1997;79:1339–1342. [DOI] [PubMed] [Google Scholar]
  • 20. Schneider CA, Voth E, Baer F, et al. QT dispersion is determined by the extent of viable myocardium in patients with chronic Q‐wave myocardial infarction. Circulation 1997;96:3913. [DOI] [PubMed] [Google Scholar]
  • 21. DePuey EG, Nichols KN, Dobrinsky C. Ventricular ejection fraction from gated Tc‐99m sestamibi SPECT. J Nucl Med 1993;34:1871–1876. [PubMed] [Google Scholar]
  • 22. Udelson JE, Coleman PS, Metherall J, et al. Predicting recovery of severe regional ventricular dysfunction: Comparison of resting scintigraphy with 201 Tl and 99m Tc‐sestamibi. Circulation 1994;89:2552–2561. [DOI] [PubMed] [Google Scholar]
  • 23. Statters DJ, Malik M, Ward DE, et al. QT dispersion: Problems of methodology and clinical significance. J Cardiovas Electrophysiol 1994;5:672–685. [DOI] [PubMed] [Google Scholar]
  • 24. Vloka ME, Steinberg JS. QT dispersion: Current and future clinical role. J Invas Cardiol 1996;8:363–369. [PubMed] [Google Scholar]
  • 25. Huitink JM, Visser FC, Bax JJ, et al. Detection of viability after myocardial infarction: Available techniques and clinical relevance: A review. Int J Cardiol 1995;51:253. [DOI] [PubMed] [Google Scholar]
  • 26. Maddahi J, Schelbert H, Brunken R, et al. Role of thallium‐201 and PET imaging in evaluation of myocardial viability and management of patients with coronary artery disease and left ventricular dysfunction. J Nucl Med 1994;35:707–715. [PubMed] [Google Scholar]
  • 27. Martin WH, Delkeke D, Patton JA et al. FDG‐SPECT: Correlation with FDG‐PET. J Nucl Med 1995;36:988–995. [PubMed] [Google Scholar]
  • 28. Burt RW, Perkins OW, Oppenheim BE, et al. Direct comparison of fluorine‐18‐FDG SPECT, fluorine‐18‐FDG PET, and rest thallium‐201 SPECT for detection of myocardial viability. J Nucl Med 1995;36: 176–179. [PubMed] [Google Scholar]
  • 29. Bax JJ, Visser FC, Lingen A, et al. Myocardial F‐18 flurode‐oxyglucose imaging by SPECT. Clin Nucl Med 1995;20:486–490. [DOI] [PubMed] [Google Scholar]
  • 30. Bax JJ, Viseer FC, Blanksman PK, et al. Comparison of myocardial uptake of fluorine‐18‐fluorodeoxyglucose imaged with PET and SPECT in dysynergic myocardium. J Nucl Med 1996;37:1631–1636. [PubMed] [Google Scholar]
  • 31. Bax JJ, Cornel JH, Viseer FC, et al. Prediction of improvement of contractile function in patients with ischemic ventricular dysfunction after revascularization by fluorine‐18 fluorodeoxyglucose SPECT. J Am Coll Cardiol 1997;30:377–383. [DOI] [PubMed] [Google Scholar]
  • 32. Dilzisian V, Rocco TP, Freedmann NMT, et al. Enhanced detection of ischemic but viable myocardium by reinjection of thallium after stress redistribution imaging. N Engl J Med 1990;323:141–146. [DOI] [PubMed] [Google Scholar]
  • 33. Arnese M, Cornel JH, Slustri A, et al. Prediction of improvement of regional left ventricular function after surgical revascularization: A comparison of low‐dose dobutamine echocardiography with 201 Tl single‐photon emission computed tomography. Circulation 1995;91: 2748–2752. [DOI] [PubMed] [Google Scholar]
  • 34. La Canna G, Alfieri O, Giubbini R, et al. Echocardiography during infusion of dobutamine for identification of reversible dysfunction in patients with chronic coronary artery disease. J Am Coll Cardiol 1994;23:617–626. [DOI] [PubMed] [Google Scholar]
  • 35. Cigarroa CG, de Filippi CR, Brickner ME, et al. Dobutamine stress echocardiography identifies hibernating myocardium and predicts recovery of left ventricular function after coronary revascularization. Circulation 1993;88:430–436. [DOI] [PubMed] [Google Scholar]
  • 36. Cornel JH, Bax JJ, Fioretti PM, et al. Prediction of improvement of ventricular function after revascularization, a comparison of FOG SPECT vs low dose dobutamine echocardiography. Eur Heart] 1997;18:941–948. [DOI] [PubMed] [Google Scholar]
  • 37. Tamura A, Nagase K, Mikuriya Y, et al. Relation of Qt dispersion to infarct size and left ventricular wall motion in anterior wall acute myocardial infarction. Am J Cardiol 1999;83: 1423–1426. [DOI] [PubMed] [Google Scholar]

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