| Vagal enhancement as evidence of residual ischemia after inferior myocardial infarction. | |
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MedLine Citation:
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PMID: 19140913 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Acute inferior myocardial infarction (MI) often induces transient sinus bradycardia through vagal enhancement, known as Bezold-Jarisch reflex, which is explained by preferential distribution of vagal nerve in the inferior wall. We examined vagal activity in relation to the occurrence of residual ischemia in patients with old inferior MI and assessed its diagnostic usefulness. METHODS: Exercise myocardial scintigraphy was performed in 15 patients with old inferior MI, 19 angina pectoris (AP) patients with inferior ischemia but no MI, and 32 control subjects who had no evidence of cardiac disease. We analyzed the connection of residual ischemia in old MI with ST-segment response to exercise and with vagal activity as determined by coefficient of component variance of high frequency (CCV(HF)). RESULTS: Exercise-induced percentage change in CCV(HF) was higher in patients with old MI and residual ischemia (18.8 +/- 13.5%) and AP (5.5 +/- 9.7%) than old MI but no residual ischemia (-24.1 +/- 4.9%) or control (-22.8 +/- 4.5%, P = 0.006). Percentage change in CCV(HF) > -5% had a good diagnostic value for the detection of residual ischemia in patients with old inferior MI with sensitivity of 83%, specificity of 89%, accuracy of 87%, and positive likelihood ratio of 7.50, which was higher than that of ST-segment depression (67%, 50%, 56%, and 1.33). CONCLUSIONS: Vagal enhancement was associated with residual ischemia in old inferior MI as well as inferior AP. Measurement of CCV(HF) is useful in improving the diagnostic reliability of exercise electrocardiography in patients with old inferior MI. |
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Authors:
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Tatsuya Kawasaki; Yoshiki Akakabe; Michiyo Yamano; Shigeyuki Miki; Tadaaki Kamitani; Toshiro Kuribayashi; Hiroaki Matsubara; Hiroki Sugihara |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Pacing and clinical electrophysiology : PACE Volume: 32 ISSN: 1540-8159 ISO Abbreviation: Pacing Clin Electrophysiol Publication Date: 2009 Jan |
Date Detail:
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Created Date: 2009-01-14 Completed Date: 2009-03-26 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7803944 Medline TA: Pacing Clin Electrophysiol Country: United States |
Other Details:
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Languages: eng Pagination: 52-8 Citation Subset: IM |
Affiliation:
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Department of Cardiology, Matsushita Memorial Hospital, Osaka, Japan. js-k@wf6.so-net.ne.jp |
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Electrocardiography / methods* Exercise Test Female Humans Male Middle Aged Myocardial Infarction / diagnosis*, physiopathology* Myocardial Ischemia / diagnosis, physiopathology Myocardial Stunning / diagnosis*, physiopathology* Recurrence Reproducibility of Results Sensitivity and Specificity Vagus Nerve / physiopathology* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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