Advanced

Stress-induced ST elevation with or without concomitant ST depression is predictive of presence, location and amount of myocardial ischemia assessed by myocardial perfusion SPECT, whereas isolated stress-induced ST depression is not

Akil, Shahnaz LU ; Sunnersjö, Lotta; Hedeer, Fredrik LU ; Hedén, Bo LU ; Carlsson, Marcus LU ; Gettes, Leonard; Arheden, Håkan LU and Engblom, Henrik LU (2016) In Journal of Electrocardiology 49(3). p.15-307
Abstract

BACKGROUND: Evaluation of stress-induced ST deviations constitutes a central part when interpreting the findings from an exercise test. The aim of this analysis was to assess the pathophysiologic correlate of stress-induced ST elevation and ST depression with regard to presence, amount and location of myocardial ischemia as assessed by myocardial perfusion SPECT (MPS) in patients with suspected coronary artery disease.

METHODS AND RESULTS: 226 patients who had undergone bicycle stress test in conjunction with MPS were included. Of these, 198 were consecutive patients while 28 patients were included on the basis of having stress-induced ST elevation mentioned in their clinical report. The amount and location of ST changes were... (More)

BACKGROUND: Evaluation of stress-induced ST deviations constitutes a central part when interpreting the findings from an exercise test. The aim of this analysis was to assess the pathophysiologic correlate of stress-induced ST elevation and ST depression with regard to presence, amount and location of myocardial ischemia as assessed by myocardial perfusion SPECT (MPS) in patients with suspected coronary artery disease.

METHODS AND RESULTS: 226 patients who had undergone bicycle stress test in conjunction with MPS were included. Of these, 198 were consecutive patients while 28 patients were included on the basis of having stress-induced ST elevation mentioned in their clinical report. The amount and location of ST changes were related to MPS findings. Summed stress scores (SSS) from MPS images were used to measure the amount of stress-induced ischemia. The positive predictive values for detecting stress-induced ischemia were 28% for the consecutive patients with ST depression and 75% for patients with ST elevation. The maximum and sum of stress-induced ST elevations correlated with SSS (r(2)=0.58, p<0.001 and r(2)=0.73, p<0.001), whereas the maximum and sum of significant ST depressions did not (r(2)=0.022, p=0.08 and r(2)=0.024, p=0.10). The location of ST elevation corresponded to the location of ischemia by MPS (kappa=1.0), whereas the location of ST depression did not (kappa=0.20).

CONCLUSIONS: Stress-induced ST elevation, with or without concomitant ST depression, is predictive of the presence, amount and location of myocardial ischemia assessed by MPS, whereas stress-induced ST depression without concomitant ST elevation is not.

(Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Electrocardiology
volume
49
issue
3
pages
9 pages
publisher
Elsevier
external identifiers
  • Scopus:84962367721
ISSN
1532-8430
DOI
10.1016/j.jelectrocard.2016.03.016
language
English
LU publication?
yes
id
0fb0cfee-3802-4cdb-8251-ca9be4c9ead1
date added to LUP
2016-05-03 13:51:49
date last changed
2016-10-13 05:07:30
@misc{0fb0cfee-3802-4cdb-8251-ca9be4c9ead1,
  abstract     = {<p>BACKGROUND: Evaluation of stress-induced ST deviations constitutes a central part when interpreting the findings from an exercise test. The aim of this analysis was to assess the pathophysiologic correlate of stress-induced ST elevation and ST depression with regard to presence, amount and location of myocardial ischemia as assessed by myocardial perfusion SPECT (MPS) in patients with suspected coronary artery disease.</p><p>METHODS AND RESULTS: 226 patients who had undergone bicycle stress test in conjunction with MPS were included. Of these, 198 were consecutive patients while 28 patients were included on the basis of having stress-induced ST elevation mentioned in their clinical report. The amount and location of ST changes were related to MPS findings. Summed stress scores (SSS) from MPS images were used to measure the amount of stress-induced ischemia. The positive predictive values for detecting stress-induced ischemia were 28% for the consecutive patients with ST depression and 75% for patients with ST elevation. The maximum and sum of stress-induced ST elevations correlated with SSS (r(2)=0.58, p&lt;0.001 and r(2)=0.73, p&lt;0.001), whereas the maximum and sum of significant ST depressions did not (r(2)=0.022, p=0.08 and r(2)=0.024, p=0.10). The location of ST elevation corresponded to the location of ischemia by MPS (kappa=1.0), whereas the location of ST depression did not (kappa=0.20).</p><p>CONCLUSIONS: Stress-induced ST elevation, with or without concomitant ST depression, is predictive of the presence, amount and location of myocardial ischemia assessed by MPS, whereas stress-induced ST depression without concomitant ST elevation is not.</p>},
  author       = {Akil, Shahnaz and Sunnersjö, Lotta and Hedeer, Fredrik and Hedén, Bo and Carlsson, Marcus and Gettes, Leonard and Arheden, Håkan and Engblom, Henrik},
  issn         = {1532-8430},
  language     = {eng},
  month        = {05},
  number       = {3},
  pages        = {15--307},
  publisher    = {ARRAY(0x8939fa0)},
  series       = {Journal of Electrocardiology},
  title        = {Stress-induced ST elevation with or without concomitant ST depression is predictive of presence, location and amount of myocardial ischemia assessed by myocardial perfusion SPECT, whereas isolated stress-induced ST depression is not},
  url          = {http://dx.doi.org/10.1016/j.jelectrocard.2016.03.016},
  volume       = {49},
  year         = {2016},
}