Elhendy A, Geleijnse L, Salustri A, van Domburg R T, Cornel J H, Arnese M, Roelandt J R, Fioretti P M
Thoraxcenter, University Hospital Dijkzigt, Rotterdam, The Netherlands.
Eur Heart J. 1996 Apr;17(4):526-31. doi: 10.1093/oxfordjournals.eurheartj.a014904.
Conflicting results in a heterogenous patient population have been described on the functional significance of stress-induced T wave normalization in the ECG. The aim of this study was to evaluate the relationship between T wave normalization during dobutamine stress testing and stress-induced ischaemia evaluated by echocardiography and myocardial perfusion scintigraphy in patients with previous non-Q wave myocardial infarction. Among 520 patients who underwent dobutamine stress, testing in conjunction with simultaneous echocardiography and 201 thallium or sestamibi SPECT for evaluation of suspected myocardial ischaemia, 36 were selected according to the following criteria: previous non-Q wave myocardial infarction, normal QRS, negative T waves in two or more ECG leads and no significant ST segment depression or elevation at rest or during stress. Diagnosis of ischaemia relied upon the occurrence of reversible perfusion defects by scintigraphy and stress-induced wall motion abnormalities by echocardiography. During the test, T wave normalization (defined as a resting negative T wave becoming upright in one or more ECG leads during stress) occurred in 20 patients (group 1), while in 16 patients the T waves remained negative (group 2). The prevalence of ischaemia was higher in group 1 than in group 2 both by scintigraphy (85% vs 38%, P = 0.004) and by echocardiography (70% vs 32%, P = 0.02). The sensitivity, specificity and accuracy of T wave normalization in the detection of ischaemia were 74%, 77% and 75% by SPECT and 74%, 65% and 69% by echocardiography respectively.
In patients with non-Q wave myocardial infarction and suspected myocardial ischaemia, T wave normalization without concomitant ECG changes during dobutamine stress testing is associated with a higher prevalence of ischaemia compared to patients with persistent T wave inversion. This ECG finding should not be disregarded as a marker of ischaemia in that particular patient population.
关于心电图中应激诱导T波正常化的功能意义，在异质性患者群体中已有相互矛盾的结果报道。本研究的目的是评估多巴酚丁胺负荷试验期间T波正常化与经超声心动图和心肌灌注闪烁显像评估的应激诱导缺血之间的关系，研究对象为既往有非Q波心肌梗死的患者。在520例接受多巴酚丁胺负荷试验并同时进行超声心动图检查以及201铊或锝-99m甲氧基异丁基异腈单光子发射计算机断层显像（SPECT）以评估可疑心肌缺血的患者中，根据以下标准选择了36例：既往有非Q波心肌梗死、QRS波正常、两个或更多心电图导联T波倒置且静息或负荷时无明显ST段压低或抬高。缺血的诊断依赖于闪烁显像显示可逆性灌注缺损以及超声心动图显示应激诱导的室壁运动异常。试验期间，20例患者（第1组）出现T波正常化（定义为静息时倒置的T波在负荷时在一个或多个心电图导联变为直立），而16例患者的T波仍保持倒置（第2组）。通过闪烁显像（85%对38%，P = 0.004）和超声心动图（70%对32%，P = 0.02），第1组缺血的发生率均高于第2组。通过SPECT检测缺血时，T波正常化的敏感性、特异性和准确性分别为74%、77%和75%，通过超声心动图检测时分别为74%、65%和69%。
在非Q波心肌梗死且疑似心肌缺血的患者中，与持续性T波倒置的患者相比，多巴酚丁胺负荷试验期间T波正常化且无伴随心电图改变与更高的缺血发生率相关。在该特定患者群体中，这一心电图表现不应被忽视作为缺血的标志物。
