Miyakoda H, Kato M, Noguchi N, Omodani H, Osaki S, Matsumoto T, Kinugawa T, Hoshio A, Kotake H, Mashiba H
First Department of Internal Medicine, Tottori University School of Medicine, Yonago, Japan.
Jpn Circ J. 1995 Nov;59(11):725-35. doi: 10.1253/jcj.59.725.
We studied the causes of exercise-induced ST-segment elevation. Group I consisted of 15 patients with anterior myocardial infarction in the absence of a coronary artery luminal narrowing of 75% or more. Group II consisted of 36 patients with predominantly exertional angina and a luminal narrowing of 90% or more in the left anterior descending coronary artery in the absence of previous myocardial infarction. In group I, exercise-induced ST-segment elevation occurred frequently during treadmill exercise (15/15, 100%). None of the patients showed 201Tl redistribution. The standard deviation of the phase in radionuclide ventriculography increased during bicycle exercise. Of group II patients, only those with 99% narrowing and poor collaterals showed exercise-induced ST-segment elevation (13/14, 93%), whereas none of those with complete occlusion or 99% narrowing and good collaterals, or 90% narrowing showed ST-segment elevation. In group II, patients with exercise-induced ST-segment elevation showed lower 201Tl uptake during exercise and washout in the territory of the diseased vessel than those without exercise-induced ST-segment elevation. In conclusion, wall motion abnormalities may cause exercise-induced ST-segment elevation independently of myocardial ischemia. In patients with predominantly exertional angina, exercise-induced ST-segment elevation may be a marker for 99% narrowing with poor collaterals and severe myocardial ischemia.
我们研究了运动诱发ST段抬高的原因。第一组由15例无前降支冠状动脉管腔狭窄75%或以上的前壁心肌梗死患者组成。第二组由36例以劳力性心绞痛为主且左前降支冠状动脉管腔狭窄90%或以上且无前壁心肌梗死病史的患者组成。在第一组中，平板运动期间经常出现运动诱发的ST段抬高（15/15，100%）。所有患者均未出现201Tl再分布。放射性核素心室造影中相位的标准差在自行车运动期间增加。在第二组患者中，只有那些狭窄99%且侧支循环差的患者出现运动诱发的ST段抬高（13/14，93%），而那些完全闭塞或狭窄99%且侧支循环良好或狭窄90%的患者均未出现ST段抬高。在第二组中，出现运动诱发ST段抬高的患者在运动期间及运动后病变血管区域的201Tl摄取低于未出现运动诱发ST段抬高的患者。总之，壁运动异常可能独立于心肌缺血导致运动诱发的ST段抬高。在以劳力性心绞痛为主的患者中，运动诱发的ST段抬高可能是狭窄99%且侧支循环差及严重心肌缺血的一个标志。
