Cardiovascular Diseases Clinical Trial
Official title:
The Unidentified Association of Gated SPECT Abnormality With J Point Elevation
The investigators present an interesting co-incidence of Gated wall abnormality in the inferolateral wall in normal sestamibi myocardial perfusion images with J wave in the inferior derivations of the ECG in a patient. The subsequent coronary angiography demonstrated 80% mid right coronary artery (RCA) stenosis, which was intervened with a drug-eluting stent. The investigators conclude that even though the myocardial perfusion is normal, the association of gated wall abnormality with J wave presentation within the same location should be further evaluated.
The isolated J-point elevation considered as a type of "early repolarization" pattern (ER),
is commonly been regarded as a benign finding. However, ER associations with arrhythmic
sudden death from CAD or sudden cardiac death due to either idiopathic ventricular
fibrillation have been shown. A recent study reported that ER especially in inferior leads,
was related to worse cardiac outcomes in patients with CAD and they argue that ER in patients
with CAD seems to be associated with the myocardial scar in the absence of pathologic Q
waves.
Likewise, it is rare to detect clinically important gated SPECT abnormalities in normal
myocardial perfusion studies with normal transient ischemic dilatation (TID) score and
without any right ventricular uptake or any pulmonary uptake. Normal myocardial perfusion
findings with wall motion abnormalities are frequently encountered in the interventricular
septum of the patients who have previous bypass surgery or in patients with left bundle
branch block (LBBB). However, the presented patient did not have the history of any
intervention or LBBB. Perfusion and function discordance can be encountered in non-ischemic
dilated cardiomyopathy patients; nonetheless, EF is markedly reduced in these patients.
The presented case, J point elevation in the ECG associated with relative wall motion
abnormality was an important clue to determine CAD in the lack of evident perfusion defects
or significant ECG findings.
The presence of wall motion abnormalities during stress study to predict CAD in patients with
normal perfusion pattern, owing to balanced ischemia, was not only reported in multi-vessel
disease but also in single-vessel disease without having presented the association between
either regional wall motion abnormality or a localized particular ECG pattern and culprit
lesion territory.
The interesting part of the presented case is, notwithstanding the myocardial perfusion
pattern is normal, the abnormal gated finding with ECG changes having the concordant
localization can be a significant milestone on the way to the diagnosis. To the best of
investigators knowledge, the association between J point elevation and wall motion
abnormality have not been described yet. Therefore, the investigators would like to draw
attention to the importance of adjoining trivial ECG changes and wall motion abnormality for
readers anymore.
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