[Elevation of the ST segment during physical exertion: computer analysis, comparison with angiographic data; clinical...

A total of 41 male patients responding with ST elevation to treadmill exercise were investigated using coronaro- and ventriculography, and sector-scanning echocardiography. All the patients had a history of anterior myocardial infarction. Computer analysis of changes in ST interval showed ST incline and integral to be the most informative parameters. Angiographically, marked stenosis (75% and more of the lumen) of one coronary artery was established in 21, two arteries, in 10, and three arteries, in 2 patients; coronary arteries were intact in 1 case. It is suggested that resting ST elevation as recorded from the leads with QS complex is more commonly associated with left ventricular aneurysm. The location of exercise-related ST elevation correlates well with marked proximal stenosis of a corresponding coronary artery an is not dependent on the presence of left ventricular aneurysm or the number of affected arteries. In patients with a history of transmural anterior myocardial infarction, the elevation of ST interval in response to exercise is due to dyssynergy of the left ventricular wall, rather than myocardial ischemia.