Document Detail


Prevalence and functional significance of transient ST-segment depression during daily life activity: comparisons of ambulatory ECG with stress redistribution thallium 201 single-photon emission computed tomographic imaging.
MedLine Citation:
PMID:  8480575     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
To assess the prevalence and functional significance of ischemic ambulatory ECG responses, we prospectively performed ambulatory ECG monitoring in 244 patients (mean age 61 +/- 10 years) referred for stress redistribution thallium 201 myocardial perfusion scintigraphy. The prevalence of ST-segment depression during ambulatory ECG was 33% among patients with a positive exercise ECG, but prevalence varied in selected patient subgroups. Among three groups with coronary artery disease (CAD), the group with ambulatory ECG ischemia (group 1) had a greater frequency of ischemic thallium responses (p = 0.07), a greater median number of reversible thallium defects (p < 0.05), and a greater summed thallium "reversibility" score (p < 0.05) than did the group with a positive exercise ECG but negative ambulatory ECG response (group 2) or that with negative exercise and ambulatory ECG responses (group 3). Exercise ST depression in group 1 versus group 2 was significantly greater (p = 0.002), occurred at a lower heart rate threshold (p = 0.002), and lasted longer after exercise (p = 0.001). Notably, one third of group 1 patients also manifested evidence of transient ischemic dilation of the left ventricle after exercise (p < 0.01 vs groups 2 and 3), a sign of severe ischemia. However, although functionally less "sick" than group 1 patients, 66% of group 2 patients and 50% of group 3 patients still had an ischemic thallium response, which was sometimes severe. Thus transient ischemia during ambulatory ECG monitoring identifies a functionally sicker cohort of patients with CAD and occurs in approximately one third of CAD patients with positive results of exercise tests. A negative ambulatory ECG response, however, does not exclude functionally significant disease among CAD patients. These results imply that caution should be applied in the interpretation of a negative ambulatory ECG response for the purpose of patient risk stratification.
Authors:
J Klein; E A Rodrigues; D S Berman; F Prigent; S Y Chao; T Maryon; A Rozanski
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American heart journal     Volume:  125     ISSN:  0002-8703     ISO Abbreviation:  Am. Heart J.     Publication Date:  1993 May 
Date Detail:
Created Date:  1993-05-27     Completed Date:  1993-05-27     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1247-57     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, Cedars Sinai Medical Center, Los Angeles, Calif.
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MeSH Terms
Descriptor/Qualifier:
Activities of Daily Living
Adult
Aged
Aged, 80 and over
Algorithms
Electrocardiography
Electrocardiography, Ambulatory*
Exercise Test
Female
Humans
Male
Middle Aged
Myocardial Ischemia / diagnosis*,  physiopathology,  radionuclide imaging
Prospective Studies
Thallium Radioisotopes / diagnostic use
Tomography, Emission-Computed, Single-Photon*
Chemical
Reg. No./Substance:
0/Thallium Radioisotopes

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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