Reciprocal ST-segment depression associated with exercise-induced ST-segment elevation indicates residual viability after myocardial infarction

OBJECTIVES We evaluated the clinical significance of reciprocal ST-segment-depression associated with exercise-induced ST-segment elevation for detecting residual viability within the infarcted area. BACKGROUND :Although the relation between residual viability and exercise-induced ST-segment elevation has been described, there are no reports focusing on the relation between myocardial viability and reciprocal ST-segment depression associated with exercise-induced ST-segment elevation. METHODS We evaluated regional blood flow and glucose utilization using N-13 ammonia (NH3) and F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) in 30 patients with a previous Q-wave myocardial infarction (anterior in 15, inferior in 15). All subjects had single-Vessel disease and had exercise-induced ST-segment elevations (greater than or equal to 1 mm) in electrocardiographic leads. RESULTS Reciprocal ST-segment depression (greater than or equal to 1 mm) was present in 16 patients (Group A; anterior in 6, inferior in 10) but not in the remaining 14 patients (Group B). The degree of exercise-induced ST-segment elevation (1.8 +/- 0.2 vs. 2.0 +/- 0.2 mm) and the time from the onset of infarction to the study (75 +/- 49 vs. 74 +/- 52 days) did not differ between groups. There were no significant differences between groups in the severity of left Ventricular dysfunction and the residual luminal narrowing in the infarct-related artery(45 +/- 21 vs. 48 +/- 25%). The presence and site of infarction were confirmed by NH3-PET in all patients. FDG-PET demonstrated residual tissue viability within infarct-related area in all patients in Group A and in 3 (21%) of 14 patients in Group B (p < 0.01). The sensitivity, specificity and accuracy of reciprocal ST-segment depression associated with exercise-induced ST-segment elevation for detecting residual viability were 84%, 100% and 90%, respectively. CONCLUSIONS The occurrence of reciprocal ST-segment depression associated with exercise-induced ST segment elevation in patients with a previous Q-wave infarction who had single-vessel disease indicates residual tissue viability within the infarct-related area. (C) 1999 by the American College of Cardiology.