Exercise-induced T-wave normalization predicts recovery of regional contractile function after anterior myocardial infarction

Giuseppe Pizzetti, M. Montorfano, G. Belotti, A. Margonato, C. Ballarotto, S. L. Chierchia

Research output: Contribution to journalArticle

Abstract

Aims. We investigated the ability of T-wave pseudonormalization 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 myocardial 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 submaximal 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.

Original languageEnglish
Pages (from-to)420-428
Number of pages9
JournalEuropean Heart Journal
Volume19
Issue number3
DOIs
Publication statusPublished - Mar 1998

Fingerprint

Myocardial Infarction
Exercise
Perfusion
Recovery of Function
Creatine Kinase
Exercise Test
Left Ventricular Function
Infarction
Echocardiography
Coronary Vessels
Electrocardiography
Heart Rate
Therapeutics

Keywords

  • Recent anterior myocardial infarction
  • T-wave pseudonormalization
  • Viability

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Exercise-induced T-wave normalization predicts recovery of regional contractile function after anterior myocardial infarction. / Pizzetti, Giuseppe; Montorfano, M.; Belotti, G.; Margonato, A.; Ballarotto, C.; Chierchia, S. L.

In: European Heart Journal, Vol. 19, No. 3, 03.1998, p. 420-428.

Research output: Contribution to journalArticle

@article{2a26b8ec42b4433e81307ea98e959c7b,
title = "Exercise-induced T-wave normalization predicts recovery of regional contractile function after anterior myocardial infarction",
abstract = "Aims. We investigated the ability of T-wave pseudonormalization 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 myocardial 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 submaximal 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.",
keywords = "Recent anterior myocardial infarction, T-wave pseudonormalization, Viability",
author = "Giuseppe Pizzetti and M. Montorfano and G. Belotti and A. Margonato and C. Ballarotto and Chierchia, {S. L.}",
year = "1998",
month = "3",
doi = "10.1053/euhj.1997.0772",
language = "English",
volume = "19",
pages = "420--428",
journal = "European Heart Journal",
issn = "0195-668X",
publisher = "Oxford University Press",
number = "3",

}

TY - JOUR

T1 - Exercise-induced T-wave normalization predicts recovery of regional contractile function after anterior myocardial infarction

AU - Pizzetti, Giuseppe

AU - Montorfano, M.

AU - Belotti, G.

AU - Margonato, A.

AU - Ballarotto, C.

AU - Chierchia, S. L.

PY - 1998/3

Y1 - 1998/3

N2 - Aims. We investigated the ability of T-wave pseudonormalization 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 myocardial 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 submaximal 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.

AB - Aims. We investigated the ability of T-wave pseudonormalization 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 myocardial 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 submaximal 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.

KW - Recent anterior myocardial infarction

KW - T-wave pseudonormalization

KW - Viability

UR - http://www.scopus.com/inward/record.url?scp=0032032245&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032032245&partnerID=8YFLogxK

U2 - 10.1053/euhj.1997.0772

DO - 10.1053/euhj.1997.0772

M3 - Article

C2 - 9568446

AN - SCOPUS:0032032245

VL - 19

SP - 420

EP - 428

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 3

ER -