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Normalization of abnormal T-waves during stress testing does not identify patients with reversible perfusion defects
Henry S Loeb1, Nicholas C Friedman
1Department of Cardiology, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois 60141, USA. HSL4134@yahoo.com
Insights
T-wave normalization during stress testing is not a reliable indicator for identifying myocardial ischemia. This finding suggests that relying solely on T-wave changes during stress tests may lead to misdiagnosis.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Electrocardiography
Background:
- Abnormal T-waves on baseline electrocardiograms can indicate underlying cardiac conditions.
- Stress testing is commonly used to evaluate for myocardial ischemia.
Purpose of the Study:
- To assess the diagnostic accuracy of T-wave normalization during stress testing for identifying myocardial ischemia.
Main Methods:
- Exercise or dobutamine stress tests with perfusion scintigraphy were conducted in 1,173 patients with baseline abnormal T-waves.
- Perfusion scintigraphy results were compared between patients with and without stress-induced T-wave normalization.
Main Results:
- Only 12.2% of patients with reversible perfusion defects showed T-wave normalization during stress.
- A significant majority (76.4%) of patients with T-wave normalization did not have reversible perfusion defects.
Conclusions:
- T-wave normalization during stress testing demonstrates low sensitivity for detecting stress-induced myocardial ischemia.
- The positive predictive value of T-wave normalization for reversible myocardial ischemia is poor.
Objective:
To determine if T-wave normalization during exercise or dobutamine stress testing identified patients with myocardial ischemia as indicated by reversible perfusion defects.
Methods:
Exercise or dobutamine stress tests with perfusion scintigraphy were performed in 1,173 patients with abnormal T-waves on their baseline electrocardiograms. The results of perfusion scintigraphy were compared in patients with and without stress-induced T-wave normalization.
Results:
Only 33 of 270 patients with reversible perfusion defects (12.2%) had T-wave normalization during stress while 76.4% of 140 patients who had T-wave normalization during stress did not have a reversible perfusion defect. Results were similar for patients who did or did not reach 85% of their maximal predicted heart rate, for patients with and without Q-wave infarction on the baseline EKG and for patients who did or did not have ischemic ST-segment depression during stress.
Conclusions:
T-wave normalization during stress testing has low sensitivity and poor positive predictive value for stress-induced reversible myocardial ischemia.
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