摘要
We investigated whether spontaneous normalization of negative T waves (TWN) on infarct-related ECG leads (IRLs) in the chronic phase of Q wave anterior myocardial infarction (MI) could be a predictor of residual viability ininfarct areas.W e prospectively studied 35patients(age60±8.6years)in the chronic phase of Q wave anteriorM I.Spontaneous TW N (group A,n =23)were defined asnegative T waves thatbecam e upright(≥0.15m V )in ≥2IRLs.The presence ofnegative T waves(group B,n =12)was defined assym m etric orbiphasic negative T wave of≥0.15m V.Allpatients underwentsam e day rest201TI-stress99m Tc sestam ibi dual-isotope m yocardial perfusion SPECTand 24-hour 201TI reinjection im aging for ischem ia and vi-ability analysis.On scintigraphic exam ination,ischecm icor viable m yocardial segm ents were found in 18patients(78%)with TW N and 4patients(33%)ofgroup B (p =0.013).The use of TW N as a param eter had a m arkedinfluence on the sensitivity(82% ),specificity(62% ),positive(78%)and negative(67%)predictive values andaccuracy(74%)ofthe diagnosis ofviable m yocardium .Ifwe add the criterion ofpositive T waves in aVR with neg-ative T waves to our criteria,we found that sensitivity(90% ),positive(80% )and negative(80% )predictivevalues and accuracy(80% )increased.The results of ourstudy suggestthatanalysis ofTW N on IRLs is an accuratem arker of residual viability and /or persistent periinfarctischem ia in patients in the chronic stage ofQ wave anteriorM I,and therefore optim izes the diagnostic and therapeuticstrategies afterM I.
We investigated whether spontaneous normalization of negative T waves (TWN) on infarct-related ECG leads (IRLs) in the chronic phase of Q wave anterior myocardial infarction (MI) could be a predictor of residual viability ininfarct areas.W e prospectively studied 35patients(age60±8.6years)in the chronic phase of Q wave anteriorM I.Spontaneous TW N (group A,n =23)were defined asnegative T waves thatbecam e upright(≥0.15m V )in ≥2IRLs.The presence ofnegative T waves(group B,n =12)was defined assym m etric orbiphasic negative T wave of≥0.15m V.Allpatients underwentsam e day rest201TI-stress99m Tc sestam ibi dual-isotope m yocardial perfusion SPECTand 24-hour 201TI reinjection im aging for ischem ia and vi-ability analysis.On scintigraphic exam ination,ischecm icor viable m yocardial segm ents were found in 18patients(78%)with TW N and 4patients(33%)ofgroup B (p =0.013).The use of TW N as a param eter had a m arkedinfluence on the sensitivity(82% ),specificity(62% ),positive(78%)and negative(67%)predictive values andaccuracy(74%)ofthe diagnosis ofviable m yocardium .Ifwe add the criterion ofpositive T waves in aVR with neg-ative T waves to our criteria,we found that sensitivity(90% ),positive(80% )and negative(80% )predictivevalues and accuracy(80% )increased.The results of ourstudy suggestthatanalysis ofTW N on IRLs is an accuratem arker of residual viability and /or persistent periinfarctischem ia in patients in the chronic stage ofQ wave anteriorM I,and therefore optim izes the diagnostic and therapeuticstrategies afterM I.
