Gated SPECT Abnormality With J Point Elevation
Condition: Cardiovascular Diseases; Electrocardiogram: Electrical Alternans; Myocardial Ischemia; Early Repolarization Syndrome; Left Ventricular Hypokinesia
MeSH terms: Hypokinesia; Cardiovascular Diseases; Myocardial Ischemia; Ischemia
Study type: Observational

Summary: 
      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.
    

Detailed description: 
      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.
    

Observational model: Other
Time perspective: Other
Sampling method: Non-Probability Sample
Study population: 
        Case Report