Myocardial perfusion and angiographic correlations in patients with ST-segment elevation during dobutamine stress perfusion imaging

Background There is scanty information on the angiographic and myocardial p erfusion correlates of dobutamine-induced ST-segment elevation. Methods and Results. We studied 39 patients who exhibited ST-segment elevat ion during dobutamine perfusion tomography and had recent coronary angiogra phy performed tie, within 3 months of the dobutamine study). Baseline chara cteristics, extent of coronary artery disease, relationship of Q waves to S T-segment elevation, ischemic burden, and angiographic findings were assess ed. Twenty-nine patients (74%) had prior myocardial infarction, and 77% had abnormal Q waves at baseline. Ninety-three percent of patients had abnorma l perfusion imaging, Eighty percent of patients had multivessel coronary ar tery disease. The left ventricular ejection fraction by contrast ventriculo graphy was 35% +/- 7% (mean +/- SD), the perfusion defect size was 32% +/- 15%, and 73% of patients had some degree of myocardial ischemia, A predomin ance of ischemia (> 50% reversibility) occurred in 38% of patients with Q w aves and in 70% of those without Q waves. There was also good agreement bet ween the site of ST-segment elevation and the site of ischemia by perfusion imaging (79%) and between the site of ST-segment elevation and the locatio n of the vessel with significant coronary stenosis (95 %), Conclusions. Patients with dobutamine-induced ST-segment elevation have a d epressed left ventricular ejection fraction, a high frequency of multivesse l disease, and markedly abnormal myocardial perfusion tomography, In patien ts with ST-segment elevation and abnormal Q waves, substantial scarring and superimposed ischemia coexist, whereas in patients without Q waves, ST-seg ment elevation usually denotes severe ischemia.