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Exercise-Induced Electrocardiographic Changes in Patients with Chronic Respiratory Diseases: Differential Diagnosis by 99mTc-Tetrofosmin SPECT

Atsushi Hirotani, MD1, Ryoji Maekura, MD, PhD1, Yoshinari Okuda, MD1, Kenji Yoshimura, MD1, Koichi Moriguchi, MD1, Seigo Kitada, MD1, Toru Hiraga, MD, PhD1, Masami Ito, MD, PhD1, Takeshi Ogura, MD, PhD1 and Toshio Ogihara, MD, PhD2

1 Department of Internal Medicine, Toneyama National Hospital, Toneyama, Osaka, Japan
2 Department of Geriatric Medicine, Osaka University Graduate School of Medicine, Osaka, Japan



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  		FIGURE 1. Patient recruitment. Only those who had no history of CAD, no sign of bundle branch block at rest, and positive exercise-induced ST depression, including II, III, and aVF leads, were recruited.

 


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  		FIGURE 2. Midventricular short-axis imaging of representative CRD patients with RV overload (A) and perfusion ischemia (B). (A) Visualization and dilatation of RV both at rest (bottom panel) and during exercise (top panel). RV/LV ratio was greater during exercise than at rest (11.1% and 8.9%, respectively). (B) Typical perfusion ischemia in inferior wall during exercise (top panel) and normal perfusion at rest (bottom panel). RV could not be visualized in either image.

 


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  		FIGURE 3. Relationship between ischemia and RV overload in chronic respiratory disease.

 


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  		FIGURE 4. RV/LV count ratio at rest and during exercise. *P < 0.01 by unpaired t test. {dagger}P < 0.05 by paired t test.

 




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