Chest, Vol 94, 512-516, Copyright © 1988 by American College of Chest Physicians

ARTICLES

Significance of T-wave pseudonormalization during exercise. A radionuclide angiographic study [published erratum appears in Chest 1989 Jan;95(1):252]

CJ Lavie, JK Oh, HT Mankin, IP Clements, ER Giuliani and RJ Gibbons
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905.

In 84 consecutive patients with resting T-wave inversion, radionuclide angiography revealed significant new wall motion abnormalities in 13 (28 percent) of the 47 patients with persistent T-wave inversion and in 23 (62 percent) of the 37 patients with T-wave pseudonormalization during exercise (p less than 0.01). The response of the ejection fraction to exercise was better in patients with persistent T-wave inversion than in those with pseudonormalization (p less than 0.04). Mechanical evidence of ischemia was seen in 14 (61 percent) of the 23 patients with T-wave pseudonormalization but without ST-segment depression. In patients with resting T-wave inversion, pseudonormalization was slightly more sensitive but less specific than a positive exercise test for predicting significant new wall motion abnormalities or decreases in the ejection fraction with exercise. Although pseudonormalization is not extremely useful alone, the presence or absence of this finding can increase the diagnostic accuracy of exercise electrocardiography in patients with resting T- wave inversion and suspected ischemic heart disease.