Fukui S, Sato H, Ogidani N, Miyake S, Sato K, Minamino T, Inoue M, Abe H
Jpn Circ J. 1981 Oct;45(10):1131-7. doi: 10.1253/jcj.45.1131.
In order to investigate the clinical significance of exercise-induced ST changes in patients with prior myocardial infarction, we performed an exercise tolerance test using bicycle ergometer, coronary arteriography and left ventriculography in 77 patients with prior myocardial infarction and compared exercise-induced ST changes with coronary arteriographic and left ventriculographic findings. At end-point time in the exercise test, we observed abnormal ST elevation in 36 patients (46.7%), ST depression in 11 (14.3%) and no significant ST changes in the remaining 30 (39.0%). After exercise, 29 out of 48 patients (60.4%) with prior anterior myocardial infarction had significant ST elevation, 9 (18.8%) had ST depression, and 10 patients (20.8%) had no significant ST changes. Of the 29 patients with exercise-induced ST elevation, 26 (89.6%) had no significant coronary lesion or simply had single vessel disease, and 6 of 9 patients with ST depression (66.7%) had multiple vessel disease. Furthermore, 18 of 29 patients with exercise-induced ST elevation (62.1%) had dyskinesis, 8 (27.6%) had akinesis and only 3 (10.3%) had hypokinesis. ON the other hand, only 2 of 9 patients with exercise-induced ST depression (22.2%) had dyskinesis, 5 had akinesis, and 2 had hypokinesis. Only 7 out of 29 patients (24.1%) with prior inferior myocardial infarction had ST elevation, 2 (6.9%) had ST depression, and no significant ST changes were observed in the remaining 20 (69.0%). No significant correlation was obtained between exercise-induced ST changes and coronary arteriographic and left ventriculographic findings. These findings strongly suggest that exercise-induced ST elevation is commonly observed in patients with anterior myocardial infarction and correlated with the severity of abnormal left ventricular wall movement, and ST depression is related with the extent of coronary artery lesion.
为了研究既往心肌梗死患者运动诱发ST段改变的临床意义，我们对77例既往心肌梗死患者进行了自行车测力计运动耐量试验、冠状动脉造影和左心室造影，并将运动诱发的ST段改变与冠状动脉造影及左心室造影结果进行比较。在运动试验的终点时间，我们观察到36例患者（46.7%）出现ST段异常抬高，11例（14.3%）出现ST段压低，其余30例（39.0%）无明显ST段改变。运动后，48例既往前壁心肌梗死患者中有29例（60.4%）出现明显ST段抬高，9例（18.8%）出现ST段压低，10例患者（20.8%）无明显ST段改变。在29例运动诱发ST段抬高的患者中，26例（89.6%）无明显冠状动脉病变或仅有单支血管病变，而9例ST段压低患者中有6例（66.7%）有多支血管病变。此外，29例运动诱发ST段抬高的患者中有18例（62.1%）出现运动障碍，8例（27.6%）出现运动不能，只有3例（10.3%）出现运动减弱。另一方面，9例运动诱发ST段压低的患者中只有2例（22.2%）出现运动障碍，5例出现运动不能，2例出现运动减弱。29例既往下壁心肌梗死患者中只有7例（24.1%）出现ST段抬高，2例（6.9%）出现ST段压低，其余20例（69.0%）未观察到明显ST段改变。运动诱发的ST段改变与冠状动脉造影及左心室造影结果之间未获得显著相关性。这些发现强烈提示，运动诱发的ST段抬高在前壁心肌梗死患者中常见，并与左心室壁运动异常的严重程度相关，而ST段压低与冠状动脉病变范围相关。
