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Predictors of an ischemic electrocardiographic response in patients with exercise-induced myocardial ischemia

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

The determinants of an ischemic electrocardiographic (ECG) response in patients with exercise-induced ischemia on single-photon emission computed tomography (SPECT) remain poorly defined. Specifically, it is unknown whether the occurrence of an ischemic ECG response is related to the extent and/or severity of SPECT ischemia.

Methods and Results

Among 3,294 patients who underwent exercise SPECT using a rest thallium-201/exercise Tc-99m sestamibi protocol, 699 (21%) patients had myocardial ischemia defined as summed difference score (SDS) ≥2. The extent of SPECT ischemia was further defined as the total number of segments with difference score ≥1, and severity of ischemia as the largest difference score among all segments. Patients with ischemic ECG changes (n = 315) were significantly older and had a significantly greater prevalence of hyperlipidemia. SDS (7.4 ± 2.2 vs 4.7 ± 1.9, P < .0001), extent (4.2 ± 2.6 vs 2.9 ± 1.7, P < .0001), and severity (2.8 ± 0.9 vs 2.3 ± 0.8, P < .0001) of SPECT ischemia were greater among patients with ischemic ECG changes. In multivariate analysis, age and SDS (which is a composite of the extent and severity of ischemia) were associated with ischemic ECG. When analyzed in a separate model which did not include SDS, both severity of SPECT ischemia (OR 1.42, CI 1.13-1.79) and extent of SPECT ischemia (OR 1.21, CI 1.10-1.33) were independently associated with ischemic ECG.

Conclusions

Among patients with exercise-induced myocardial ischemia by SPECT, age and SDS were associated with ischemic ECG changes. When analyzed separately, the severity and extent of SPECT ischemia were both independent predictors of ischemic ECG changes.

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References

  1. Hauser TH, Dorbala S, Sulaiman A, Di Carli MF. Quantitative relation of ST-segment depression during exercise to the magnitude of myocardial ischemia as assessed by single-photon emission computed tomographic myocardial perfusion imaging. Am J Cardiol 2004;94:703-8.

    Article  PubMed  Google Scholar 

  2. Polizos G, Ellestad MH. The value of upsloping ST depression in diagnosing myocardial ischemia. Ann Noninvasive Electrocardiol 2006;11:237-40.

    Article  PubMed  Google Scholar 

  3. Bruce RA, Hornsten TR. Exercise stress testing in evaluation of patients with ischemic heart disease. Prog Cardiovasc Dis 1969;11:371-90.

    Article  PubMed  CAS  Google Scholar 

  4. Martin CM, McConahay DR. Maximal treadmill exercise electrocardiography. Correlations with coronary arteriography and cardiac hemodynamics. Circulation 1972;46:956-62.

    PubMed  CAS  Google Scholar 

  5. Berman DS, Kiat H, Friedman JD, Wang FP, van Train K, Matzer L, et al. Separate acquisition rest thallium-201/stress technetium-99m sestamibi dual-isotope myocardial perfusion single-photon emission computed tomography: A clinical validation study. J Am Coll Cardiol 1993;22:1455-64.

    Article  PubMed  CAS  Google Scholar 

  6. Gallowitsch HJ, Sykora J, Mikosch P, Kresnik E, Unterweger O, Molnar M, et al. Attenuation-corrected thallium-201 single-photon emission tomography using a gadolinium-153 moving line source: Clinical value and the impact of attenuation correction on the extent and severity of perfusion abnormalities. Eur J Nucl Med 1998;25:220-8.

    Article  PubMed  CAS  Google Scholar 

  7. Kang X, Berman DS, Van Train KF, Amanullah AM, Areeda J, Friedman JD, et al. Clinical validation of automatic quantitative defect size in rest technetium-99m-sestamibi myocardial perfusion SPECT. J Nucl Med 1997;38:1441-6.

    PubMed  CAS  Google Scholar 

  8. Hachamovitch R, Berman DS, Kiat H, Cohen I, Cabico JA, Friedman J, et al. Exercise myocardial perfusion SPECT in patients without known coronary artery disease: Incremental prognostic value and use in risk stratification. Circulation 1996;93:905-14.

    PubMed  CAS  Google Scholar 

  9. Guallar E, Silbergeld EK, Navas-Acien A, Malhotra S, Astor BC, Sharrett AR, et al. Confounding of the relation between homocysteine and peripheral arterial disease by lead, cadmium, and renal function. Am J Epidemiol 2006;163:700-8.

    Article  PubMed  Google Scholar 

  10. Cleves MA. Comparing areas under receiver operating characteristic curves from two or more probit or logit models. Stata J 2002. http://www.ats.ucla.edu/stat/stata/ado/analysis/.

  11. Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J, et al. Exercise standards for testing and training: A statement for healthcare professionals from the American Heart Association. Circulation 2001;104:1694-740.

    Article  PubMed  CAS  Google Scholar 

  12. Colby J, Hakki AH, Iskandrian AS, Mattleman S. Hemodynamic, angiographic and scintigraphic correlates of positive exercise electrocardiograms: Emphasis on strongly positive exercise electrocardiograms. J Am Coll Cardiol 1983;2:21-9.

    Article  PubMed  CAS  Google Scholar 

  13. Bogaty P, Guimond J, Robitaille NM, Rousseau L, Simard S, Rouleau JR, et al. A reappraisal of exercise electrocardiographic indexes of the severity of ischemic heart disease: Angiographic and scintigraphic correlates. J Am Coll Cardiol 1997;29:1497-504.

    Article  PubMed  CAS  Google Scholar 

  14. Tavel ME, Shaar C. Relation between the electrocardiographic stress test and degree and location of myocardial ischemia. Am J Cardiol 1999;84:119-24.

    Article  PubMed  CAS  Google Scholar 

  15. Katzel LI, Sorkin KD, Colman E, Goldberg AP, Busby-Whitehead MJ, Lakatta LE, et al. Risk factors for exercise-induced silent myocardial ischemia in healthy volunteers. Am J Cardiol 1994;74:869-74.

    Article  PubMed  CAS  Google Scholar 

  16. Gulati M, Pratap P, Kansal P, Calvin JE Jr, Hendel RC. Gender differences in the value of ST-segment depression during adenosine stress testing. Am J Cardiol 2004;94:997-1002.

    Article  PubMed  CAS  Google Scholar 

  17. Liao Y, Liu K, Dyer A, Schoenberger JA, Shekelle RB, Collette P, et al. Sex differential in the relationship of electrocardiographic ST-T abnormalities to risk of coronary death: 11.5 year follow-up findings of the Chicago Heart Association Detection Project in Industry. Circulation 1987;75:347-52.

    Article  PubMed  CAS  Google Scholar 

  18. Gibbons RJ, Balady GJ, Beasley JW, Bricker TJ, Duvernoy WF, Froelicher VF, et al. ACC/AHA guidelines for exercise testing. A report of the American college of cardiology/American heart Association task force on practice guidelines (committee on exercise testing). J Am Coll Cardiol 1997;30:260-315.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Saurabh Malhotra MD, MPH

  2. Division of Cardiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA

    William P. Follansbee MD & Prem Soman MD, PhD, FRCP(UK)

Authors
  1. Saurabh Malhotra MD, MPH
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  2. William P. Follansbee MD
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  3. Prem Soman MD, PhD, FRCP(UK)
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Corresponding author

Correspondence to Prem Soman MD, PhD, FRCP(UK).

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Malhotra, S., Follansbee, W.P. & Soman, P. Predictors of an ischemic electrocardiographic response in patients with exercise-induced myocardial ischemia. J. Nucl. Cardiol. 18, 678–684 (2011). https://doi.org/10.1007/s12350-011-9409-5

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  • DOI: https://doi.org/10.1007/s12350-011-9409-5

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