Copyright © 1998 by the European Society of Cardiology.
Exercise-induced T-wave normalization predicts recovery of regional contractile function after anterior myocardial infarction
Department of Cardiology, Istituto Scientifico H.S.Raffaele, Milano, Italy
accepted August 14, 1997
Aims
We investigated the ability of T-wave pseudo-normalization and ST-segment elevation, which are demonstrated in infarct-related leads during submaximal exercise testing, to predict late recovery of contractile function.
Methods
We studied 88 consecutive patients (73 males, mean age 59±8 years) with anterior infarction, persistent T-wave inversion and a documented lesion of the proximal segment of the left anterior descending coronary artery. They all underwent 2D-echocardiography on admission, 4 weeks as well as 6 months after myocardial infarction to evaluate the dysfunction score and the ejection fraction. Submaximal (75% of maximal predicted heart rate) exercise testing was performed in 80 patients 2 weeks after myo-cardial infarction following discontinuation of treatment.
Results
During exercise testing, 59 of the 88 patients showing negative T-waves on the resting electrocardiogram exhibited pseudonormalization (group A) in at least three adjacent precordial leads, whilst 29 (group B) did not. Patients of group A more frequently exhibited an early creatine kinase peak (41% vs 24%, P<0·05) and residual angiographic perfusion (97% vs 69%, P<0·05). The dysfunction score did not change in group B (from 19±7 to 22±4), but decreased in group A (from 18±4 to 11±6, P<0·05). The ejection fraction was similar in the two groups on admission (group A: 48±7%, group B: 45±10%), but was significantly different at 4-week (52±99 vs 42±11%, P<0·05) and 6-month follow-up (58±9 vs 44±10%, P<0·01). The concomitant presence of ST-segment elevation and T-wave normalization showed the highest positive predictive value for left ventricular function recovery (100%).
Conclusions
T-wave normalization induced by sub-maximal exercise test is frequently associated with residual perfusion to the infarct area and predicts progressive improvement in regional wall motion, especially if associated with ST-segment elevation. Therefore, these electrocardiographic findings may be used as easily obtainable markers of residual viability that predict late recovery in contractile function.
Key Words: T-wave pseudonormalization • viability • recent anterior myocardial infarction.
Presented in part at the XVIth Congress of the European Society of Cardiology and XIIth World Congress of Cardiology held in Berlin, Germany, 10–14 September 1994.
f2 Correspondence: Giuseppe Pizzetti, MD, Department of Cardiology, Istituto Scientifico H.S.Raffaele, Via Olgettina, 60, 20132 Milano, Italy.
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