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Related Experiment Videos

Does chronic ST segment elevation following Q wave myocardial infarction exclude tissue viability?

Walid Saber1, Erna Obenza Nishime, Richard C Brunken

  • 1Department of Internal Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio 44053, USA. wdsaber@yahoo.com

Cardiology
|September 17, 2003
PubMed
Summary

Chronic ST elevation after myocardial infarction does not rule out viable heart tissue. Further assessment is needed to determine if revascularization can benefit patients with Q wave infarction and persistent ST elevation.

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Area of Science:

  • Cardiology
  • Medical Imaging
  • Electrophysiology

Background:

  • Persistent ST segment elevation after Q wave myocardial infarction (MI) traditionally suggests ventricular aneurysm and nonviable tissue.
  • Regional systolic dysfunction in the infarct zone can represent either scar or viable myocardium.
  • Positron emission tomography (PET) is a key imaging modality for differentiating viable from nonviable myocardial tissue.

Purpose of the Study:

  • To investigate whether chronic ST segment elevation following Q wave MI is associated with salvageable myocardium in the infarct region.
  • To determine if persistent ST elevation on electrocardiograms (ECGs) indicates absence of myocardial viability.
  • To explore the relationship between chronic ST elevation and the presence of viable myocardium detected by PET.

Main Methods:

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  • Reviewed ECGs of 1,229 patients undergoing PET scans for viability assessment.
  • Identified patients with chronic anteroseptal Q wave infarctions and ST segment elevation >1 mV.
  • Excluded patients with QRS duration >0.14 ms or non-sinus rhythm; defined viability by reversible perfusion defects or resting mismatch.

Main Results:

  • 132 patients had anteroseptal Q wave MI; 84 (64%) had chronic ST elevation.
  • No significant differences in baseline characteristics or left ventricular systolic function between groups.
  • Myocardial viability was present in 63% of patients with chronic ST elevation and 56% without; no relationship was found.

Conclusions:

  • Chronic ST segment elevation after Q wave MI does not preclude myocardial viability in the infarct zone.
  • Tissue viability assessment is crucial in patients with Q wave infarction and chronic ST elevation.
  • This evaluation helps determine the potential benefits of revascularization strategies.