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Is Positive ECG Changes For Ischaemia A Matter Of Concern?
Question: Hi
Had myocardial perfusion study with ECG stress test,. No symptomatic or haemodynamic evidence of ischemia, no scan evidence of myocardial ischemia but positive ECG changes for ischaemia at moderate rate workload and optimal heart rate response. Cause for concern in 60 yo male with moderate aortic stenosis/regurgitation and bicuspid aortic valve?
Had myocardial perfusion study with ECG stress test,. No symptomatic or haemodynamic evidence of ischemia, no scan evidence of myocardial ischemia but positive ECG changes for ischaemia at moderate rate workload and optimal heart rate response. Cause for concern in 60 yo male with moderate aortic stenosis/regurgitation and bicuspid aortic valve?
Brief Answer:
Please find detailed answer below
Detailed Answer:
Hi XXXX
Thanks for writing in to us.
I have read through your query in detail.
Recent medical research has been done in this area and doctors feel that moderate aortic stenosis and regurgitation and bicuspid aortic valve require regular medical attention and continued observations.
It is mentioned in a recently published research study and I quote "Seventy-one patients with at least moderate aortic stenosis and insufficiency were followed for a median of 8.9 years, and 50 of them (74%) developed indications for aortic valve replacement."
Complete article can be read at the given link
http://content.onlinejacc.org/article.aspx?articleid=0000
Hope your query is answered.
Do write back should you have any doubts.
Regards,
Dr.Vivek
Please find detailed answer below
Detailed Answer:
Hi XXXX
Thanks for writing in to us.
I have read through your query in detail.
Recent medical research has been done in this area and doctors feel that moderate aortic stenosis and regurgitation and bicuspid aortic valve require regular medical attention and continued observations.
It is mentioned in a recently published research study and I quote "Seventy-one patients with at least moderate aortic stenosis and insufficiency were followed for a median of 8.9 years, and 50 of them (74%) developed indications for aortic valve replacement."
Complete article can be read at the given link
http://content.onlinejacc.org/article.aspx?articleid=0000
Hope your query is answered.
Do write back should you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
This answer does not address my question which was whether I should be concerned by positive ECG changes for ischaemia when scans showed no evidence of myocardial ischaemia. Please answer my question.
Thanks.
Thanks.
Brief Answer:
Perfusion scan findings are to be considered
Detailed Answer:
Hi XXXX
Thanks for writing in with an update.
I appreciate your specific question concerning a positive ECG and a negative MPI (myocardial perfusion imaging) scan. There has been a large scale study involving 1460 patients who underwent ECG and MPI. As expected, there was a group of patients like you who had a positive ischemic change on ECG and a negative or normal MPI scan. This group had about 190 patients (13%). The presence of ECG changes during stress testing was not associated with more events at one year or more events throughout the follow-up period of 14.0 to 39.6 months.
In conclusion the researchers have said that when the results of MPI and ECG are discordant, it is correct to consider only the MPI results.
This research may be found at the given link
http://www.elsevier.pt/en/revistas/revista-portuguesa-cardiologia-334/artigo/discrepancy-between-stress-electrocardiographic-changes-and-nuclear-myocardial-0000
The earlier reply concerning the aortic regurgitation and stenosis is a separate but related issue and valvular disease in your case needs to be addressed appropriately.
Hope your query is answered.
Do write back should you have any doubts.
Regards,
Dr.Vivek
Perfusion scan findings are to be considered
Detailed Answer:
Hi XXXX
Thanks for writing in with an update.
I appreciate your specific question concerning a positive ECG and a negative MPI (myocardial perfusion imaging) scan. There has been a large scale study involving 1460 patients who underwent ECG and MPI. As expected, there was a group of patients like you who had a positive ischemic change on ECG and a negative or normal MPI scan. This group had about 190 patients (13%). The presence of ECG changes during stress testing was not associated with more events at one year or more events throughout the follow-up period of 14.0 to 39.6 months.
In conclusion the researchers have said that when the results of MPI and ECG are discordant, it is correct to consider only the MPI results.
This research may be found at the given link
http://www.elsevier.pt/en/revistas/revista-portuguesa-cardiologia-334/artigo/discrepancy-between-stress-electrocardiographic-changes-and-nuclear-myocardial-0000
The earlier reply concerning the aortic regurgitation and stenosis is a separate but related issue and valvular disease in your case needs to be addressed appropriately.
Hope your query is answered.
Do write back should you have any doubts.
Regards,
Dr.Vivek
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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