Tung Robert T
Department of Veterans Affairs Eastern Kansas Healthcare System, Topeka, KS.
Kans J Med. 2019 Aug 21;12(3):80-82. eCollection 2019 Aug.
The pharmacologic (regadenoson) stress myocardial perfusion imaging (MPI) is used widely in patients who cannot exercise for detecting coronary artery disease (CAD). The interpretation of these studies depends primarily on the imaging results because the sensitivity of electrocardiograms (ECG) in this setting is poor. Prior study showed that effects of regadenoson on ST-segment occurred infrequently and had low sensitivity for detecting CAD. The significance of T-wave inversion in multiple ECG leads without ST-segment depression with regadenoson injection in patients with normal MPI is described and reported.
ECGs were reviewed retrospectively in 64 patients who had regadenoson MPI and coronary angiography for evaluation of CAD from June 1, 2016 to August 31, 2018. Five cases were identified with new, isolated T-wave inversion in multiple ECG leads.
All five cases had new and isolated T-wave inversion in multiple leads without ST segment depression with regadenoson injection and normal MPI. At coronary angiography, three of the five cases showed obstructive coronary artery disease who received coronary percutaneous intervention. One case had nonobstructive coronary artery disease and one had a normal coronary artery.
Despite nonspecific ST-T changes on baseline ECGs and normal MPI in all patients, three of five cases had obstructive CAD by coronary angiography. New, isolated T-wave inversion in multiple ECG leads with regadenoson injection were observed in our patients with normal MPI. These ECG findings may be associated with false negative MPI. Therefore, careful observation and scrutiny of all ECG changes, especially new, isolated T-wave inversion in multiple ECG leads during regadenoson MPI is advisable to identify potential obstructive CAD despite normal MPI findings.
药理学（瑞加诺生）负荷心肌灌注成像（MPI）广泛应用于无法进行运动的患者，以检测冠状动脉疾病（CAD）。这些研究的解读主要依赖于成像结果，因为在此情况下心电图（ECG）的敏感性较差。先前的研究表明，瑞加诺生对ST段的影响很少发生，且检测CAD的敏感性较低。本文描述并报告了在MPI正常的患者中，注射瑞加诺生后多个ECG导联出现无ST段压低的T波倒置的意义。
回顾性分析2016年6月1日至2018年8月31日期间64例接受瑞加诺生MPI和冠状动脉造影以评估CAD的患者的ECG。发现5例患者在多个ECG导联出现新的孤立性T波倒置。
所有5例患者在注射瑞加诺生且MPI正常时，均在多个导联出现新的孤立性T波倒置且无ST段压低。冠状动脉造影显示，5例患者中有3例患有阻塞性冠状动脉疾病并接受了冠状动脉介入治疗。1例患有非阻塞性冠状动脉疾病，1例冠状动脉正常。
尽管所有患者的基线ECG均有非特异性ST-T改变且MPI正常，但冠状动脉造影显示5例患者中有3例患有阻塞性CAD。在MPI正常的患者中观察到注射瑞加诺生后多个ECG导联出现新的孤立性T波倒置。这些ECG表现可能与MPI假阴性有关。因此，在瑞加诺生MPI期间仔细观察和审视所有ECG变化，尤其是多个ECG导联出现的新的孤立性T波倒置，对于识别尽管MPI结果正常但潜在的阻塞性CAD是可取的。
