Post-exercise electrocardiographic alterations, ST-segment elevation and QTc changes in patients with recent myocardial infarction.

Abstract

UNLABELLED: Stress-induced ST-segment elevation and a prolongation or no change of the QTc ratio (corrected QT interval for heart rate) at maximal exercise in the infarct leads have been associated with the presence of residual myocardial ischemia in the infarct zone. The aim of this study was to test the agreement between stress-induced ST-segment elevation and post-exercise QTc changes in infarct leads, in 36 consecutive patients, studied by coronariography, radionuclide ventriculography and thallium-201 scintigraphy, within 3 months of the acute myocardial infarction. Sixteen patients (Group I) had exercise-induced ST-segment elevation in the infarct leads and 20 did not (Group II). The study showed no significant difference between severity of vessel disease and occlusion, prevalence of the infarct related artery or left ventricular dysfunction in Group I and II. No agreement between ST-segment shifts and myocardial perfusion in the infarct zone was found. Resting wall motion abnormalities were more severe in Group I than in Group II (p < 0.01). In the total of the 36 patients there was no agreement between ST-segment shifts and QTc-variations. The study showed agreement between QTc changes and myocardial perfusion in the infarct area (K = 0.64) (p < 0.001). CONCLUSION: This study showed no relation between post-exercise ST elevation and post-exercise QTc variations in Q wave leads. QTc variations at the end of exercise in the infarct related leads identified residual ischemia. Exercise ST segment elevation, although not a marker of ischemia, is associated with more severe wall motion abnormalities in the infarct zone.