Exercise-Induced ST-Segment Elevation : Role of Left Ventricular Wall Motion Abnormalities and Coronary Artery Narrowing

• Published in: JAPANESE CIRCULATION JOURNAL Vol. 59; no. 11; pp. 725 - 735
• Main Authors: Miyakoda, Hiroyuki, Kato, Masahiko, Noguchi, Noriyasu, Omodani, Hiroki, Osaki, Shuichi, Matsumoto, Tatsuhiko, Kinugawa, Toru, Hoshio, Akira, Kotake, Hiroshi, Mashiba, Hiroto
• Format: Journal Article
• Language: English
• Published: Kyoto The Japanese Circulation Society 1995; Japanese Circulation Society
• Subjects: Adult; Aged; Biological and medical sciences; Cardiology. Vascular system; Collateral Circulation; Constriction, Pathologic - diagnosis; Constriction, Pathologic - physiopathology; Coronary Circulation; Coronary Disease - diagnosis; Coronary Disease - physiopathology; Coronary heart disease; Electrocardiography; Exercise Test; Exercise-induced ST-segment elevation; Female; Gated Blood-Pool Imaging; Heart; Heart - diagnostic imaging; Humans; Male; Medical sciences; Middle Aged; Myocardial Contraction; Myocardial Infarction - diagnosis; Myocardial Infarction - physiopathology; Radionuclide ventriculography; Retrospective Studies; Thallium Radioisotopes; Tl myocardial imaging; Ventricular Function, Left; Radionuclide study; Human; Infarct; Cardiovascular disease; Exploration; Scintigraphy; Coronary heart disease; Myocardial disease; ST elevation; Electrodiagnosis; Ventriculography; Electrocardiography; Myocardium; Exercise tolerance test
• ISSN: 0047-1828; 1347-4839
• DOI: 10.1253/jcj.59.725

We studied the causes of exercise-induced ST-segment elevation. Group I consisted of 15 patients with anterior myocardial infarction in the absence of a coronary artery luminal narrowing of 75% or more. Group II consisted of 36 patients with predominantly exertional angina and a luminal narrowing of 90% or more in the left anterior descending coronary artery in the absence of previous myocardial infarction. In group I, exercise-induced ST-segment elevation occurred frequently during treadmill exercise (15/15, 100%). None of the patients showed 201Tl redistribution. The standard deviation of the phase in radionuclide ventriculography increased during bicycle exercise. Of group II patients, only those with 99% narrowing and poor collaterals showed exercise-induced ST-segment elevation (13/14, 93%), whereas none of those with complete occlusion or 99% narrowing and good collaterals, or 90% narrowing showed ST-segment elevation. In group II, patients with exercise-induced ST-segment elevation showed lower 201Tl uptake during exercise and washout in the territory of the diseased vessel than those without exercise-induced ST-segment elevation. In conclusion, wall motion abnormalities may cause exercise-induced ST-segment elevation independently of myocardial ischemia. In patients with predominantly exertinal angina, exercise-induced ST-segment elevation may be a marker for 99% narrowing with poor collaterals and severe myocardial ischemia.