Features of the exercise test that reflect the activity of ischemic heart disease out of hospital.

Campbell, Stephen; Barry, Joan; Rocco, Michael; Nabel, Elizabeth G.; Mead-Walters, Kimberley; Rebecca, George S.; Selwyn, Andrew P.

doi:10.1161/01.cir.74.1.72

Cited by 102 publications

(8 citation statements)

References 40 publications

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“…These results are compatible with most previous published studies based on single Holter recordings [11]. In stable angina pectoris, more patients, 41–73%, demonstrate TMI [14, 15, 16, 17, 18]. There are several potential explanations for the relatively low prevalence of episodes of TMI after AMI.…”

Section: Discussionsupporting

confidence: 91%

Serial Holter ST-Segment Monitoring after First Acute Myocardial Infarction

Mickley

Nielsen²,

Berning³

et al. 1998

Cardiology

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Based on serial Holter monitoring performed 7 times within 3 years after a first acute myocardial infarction, we assessed the prevalence, variability and long-term clinical importance of transient myocardial ischemia (TMI) defined as episodes of ambulatory ST-segment depression. In all, 121 consecutive male patients <70 years old were studied. The prevalence of TMI on different Holter recordings varied around 20% ranging between 18 and 27%. Fifty-five of the patients (46%) had TMI on at least 1 of the 7 Holter recordings. Considerable variability was found within and between patients for the presence of TMI. No high-risk group for cardiac death, nonfatal reinfarction or coronary revascularization during up to 10 years of follow-up could be identified by the detection of TMI. From these results we conclude that a routine search for TMI on serial Holter monitoring cannot be recommended in male survivors of an uncomplicated first acute myocardial infarction.

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Section: Discussionsupporting

confidence: 91%

Serial Holter ST-Segment Monitoring after First Acute Myocardial Infarction

Mickley

Nielsen²,

Berning³

et al. 1998

Cardiology

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“…Detailed characterization has revealed that 30-35% of medically treated patients with stable angina will have such episodes during their normal daily routines [17] , and that the vast majority of patients with transient (silent) ischaemia during daily life will have a positive exercise test for ischaemia [18] . Therefore a significant minority of stable coronary patients will have recurrent transient ischaemic activity despite medications over the long-term.…”

Section: Effects Of Silent Ischaemia In Stable Angina 1345mentioning

confidence: 99%

Long-term (5 year) effects of transient (silent) ischaemia on left ventricular systolic function in stable angina. Clinical and radionuclide study

Mulcahy

Gunning²,

Knight³

et al. 1998

European Heart Journal

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Aims (a) to assess short (1 year) and long-term (5 year) changes in left ventricular ejection fraction in patients with stable coronary disease with or without ECG evidence of transient ischaemia during daily life on routine therapy, and (b) to assess whether patients with recurrent transient ischaemic episodes have a particular propensity to gradual deterioration in left ventricular ejection fraction in the absence of infarction. Methods and ResultsOne hundred and forty eight patients (127 males; mean age 59 years), part of a natural history cohort of 172 patients who had undergone exercise testing, 48 h ambulatory ST monitoring, and resting radionuclide ventriculography at baseline, and who had not suffered any intervening cardiac event, underwent repeat radionuclide ventriculography at 1 year follow-up on identical or very similar medications. Furthermore, 56 patients (50 males; mean age 65 years) of this cohort, who had ischaemia both on exercise testing and ambulatory monitoring at baseline (n=33), or no ischaemia on either test at baseline (n=23), and who had suffered no intervening event, underwent repeat exercise testing, ambulatory monitoring and radionuclide ventriculography at a mean of 61·8 months follow-up. In 38 of these 56 cases, long-term testing mirrored baseline testing in terms of presence or absence of ischaemia (both tests +, n=25; both tests , n=13). At one year there was no change in left ventricular ejection fraction, either for the whole group (n=148; left ventricular ejection fraction 47=11·6% 47·13+11·07%, P=ns) or for subgroups with (n=62; left ventricular ejection fraction 48+12·1%-48·5+10·5%, P=ns) and without (n=86; left ventricular ejection fraction 46·2+10·4%-46·2+11·3%, P=ns) evidence of transient ischaemia at baseline. At 61 months, there was a small fall in mean left ventricular ejection fraction for the total study group (n=56; left ventricular ejection fraction 45·8+9·3%-42·1+8·8%, P<0·05); however, this fall was not significant for those patients with both baseline and 5 year evidence of transient ischaemia (n=25; left ventricular ejection fraction 44·9+8·7%-41·3+7·5%, P=0·056). ConclusionIn medically treated stable coronary patients who do not suffer any intervening cardiac event, recurrent transient (silent) ischaemic episodes do not, in themselves, lead to gradual deterioration in left ventricular systolic function over a 1-5 year period.

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“…If only 24-hour recording periods are included, episodes of ST-segment depression can be detected in 14-25% of patients [5,6,8,[10][11][12]16]. In stable angina pec toris, 42-73% of patients demonstrate transient episodes of myocardial ischemia [4,[17][18][19][20]. There are several explanations for the relatively low prevalence of transient myocardial ischemia in survivors of AMI.…”

Section: Prevalence and Characteristics Of Transient Myocardial Ischemiamentioning

confidence: 99%

Transient Myocardial Ischemia after Myocardial Infarction

Mickley

1995

Cardiology

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Ambulatory ST-segment monitoring is a relatively new device in the evaluation of myocardial ischemia. The method is unique in allowing us to continuously examine the patient over an extended period of time in a changing environmental milieu. In survivors of acute myocardial infarction the prevalence of ambulatory or transient myocardial ischemia is lower than in patients with chronic, stable coronary artery disease. A greater proportion of ischemic episodes, however, are silent than in other subgroups with ischemic heart disease. Early after the infarction, transient myocardial ischemia exhibits a circadian variation with a peak activity occurring in the late evening hours. Patients with non-Q wave infarction have more transient myocardial ischemia, whereas thrombolytic therapy seems to result in less residual ischemia. Exercise testing is more sensitive than ambulatory monitoring in the detection of postinfarction myocardial ischemia. There appears to be a poor association between transient myocardial ischemia and severe left ventricular dysfunction. Transient myocardial ischemia has been shown to provide prognostic information in different subsets of patients with previous myocardial infarction, but there is considerable disagreement about how this is expressed in terms of cardiac events. The precise role of postinfarction ST-segment monitoring in clinical practice has yet to be established.

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Features of the exercise test that reflect the activity of ischemic heart disease out of hospital.

Cited by 102 publications

References 40 publications

Serial Holter ST-Segment Monitoring after First Acute Myocardial Infarction

Serial Holter ST-Segment Monitoring after First Acute Myocardial Infarction

Long-term (5 year) effects of transient (silent) ischaemia on left ventricular systolic function in stable angina. Clinical and radionuclide study

Transient Myocardial Ischemia after Myocardial Infarction

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