Fifteen-year risk of major coronary events predicted by Holter ST-monitoring in asymptomatic middle-aged men

Stagmo, Martin; Juul‐Möller, Steen; Israelsson, Bo

doi:10.1097/01.hjr.0000176511.22284.c1

Cited by 8 publications

(7 citation statements)

References 39 publications

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“…Furthermore, interpretation of the ST segment on Holter recording can be challenging because left ventricular strain patterns may be difficult to differentiate from myocardial ischemia, and elevations in blood pressure can result in ST depression [44]. However, we observed a prevalence of myocardial ischemia of 3.7% before 5-FU, which is lower than the incidences reported in population-based studies of middle-aged to elderly subjects (6%-35%) [42,43,67], indicating that we did not overestimate the incidence of myocardial ischemia.…”

Section: Strengths and Limitationscontrasting

confidence: 70%

“…Silent myocardial ischemia may carry an adverse prognosis, but the clinical significance is unclarified. In coronary heart disease and among middle-aged and elderly individuals with no apparent heart disease, silent myocardial ischemia has been reported to be associated with increased risk of myocardial infarction and sudden death [40][41][42][43][44], although results are inconsistent [45]. Because ST elevation was the major finding on Holter recording in the patient sustaining cardiac arrest and ST elevations on Holter recording presented before symptoms in the two patients with myocardial infarction, myocardial ischemia may be a forerunner of severe cardiac events.…”

Section: Discussionmentioning

confidence: 99%

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Myocardial Ischemia Induced by 5-Fluorouracil: A Prospective Electrocardiographic and Cardiac Biomarker Study

et al. 2020

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Background. Cardiotoxicity induced by 5-fluorouracil (5-FU) is well known but poorly understood. In this study, we undertook ECG recording (Holter) and analyses of the biomarkers troponin and copeptin in patients receiving 5-FU to increase our understanding of the cardiotoxicity. Subjects, Materials, and Methods. Patients with colorectal or anal cancer that received first-time treatment with 5-FUbased chemotherapy were prospectively included. Holter recording, clinical evaluation, 12-lead electrocardiogram, and assessment of plasma concentrations of troponin I and copeptin were performed before (control) and during 5-FU treatment (intervention). Results. A total of 108 patients were included, 82 with colorectal and 26 with anal cancer. The proportion of patients with myocardial ischemia on Holter recording was significantly higher during the first 5-FU infusion (14.1%) than before (3.7%; p = .001). The ischemic burden per day (p = .001), the number of ST depression episodes per day (p = .003), and the total duration of ischemic episodes per day (p = .003) were higher during the first 5-FU infusion than before, as was plasma copeptin (p < .001), whereas plasma troponin I was similar (p > 0.999). Six patients (5.6%) developed acute coronary syndromes and two (1.8%) developed symptomatic arrhythmias during 5-FU treatment. Conclusion. 5-FU infusion is associated with an increase in the number of patients with myocardial ischemia on Holter recording. According to biomarker analyses, 5-FU is associated with an increase in copeptin, but rarely with increases in cardiac troponin I. However, 5%-6% of the patients developed acute coronary syndromes during treatment with 5-FU.

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Section: Strengths and Limitationscontrasting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Myocardial Ischemia Induced by 5-Fluorouracil: A Prospective Electrocardiographic and Cardiac Biomarker Study

et al. 2020

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“…A more than three-fold increase in the cardiac event rate was reported for middle-aged and elderly subjects with no apparent heart disease but with Holter-detected ST depression in a follow up of 5 years (Sajadieh et al 2005). Furthermore Stagmo and colleagues (2005) have recommended using Holter-detected ST depression as a complement to conventional risk factor evaluation, when deciding whether or not to treat risk factors for coronary heart disease in asymptomatic subjects, after they have the assessed 15-year risk of major coronary events predicted by Holter ST-monitoring in asymptomatic middle-aged men. Therefore we have not analyzed subgroups of patient with and without proven coronary heart disease in the present study.…”

Section: Discussionmentioning

confidence: 99%

ST segment depression in hypertensive patients: A comparison of exercise test versus Holter ECG

Uen¹

2008

VHRM

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Introduction:This study compared ST segment depression (ST depression) during cycle ergometry (ergometry) versus simultaneous 24-hour ambulatory blood pressure measurement and electrocardiogram recording (24-h ABPM/ECG) during everyday life. Methods: In a German multicenter study, ergometry and 24-h ABPM/ECG records of 239 hypertensive patients were retrospectively analyzed. ST depression was defi ned as an ST segment depression (1 mm limb or chest recordings V1 to V6) in an incremental cycle ergometry, or 1 mm in the 24-h ABPM/ECG recording under everyday conditions. Blood pressure parameters at the onset of ST depression in the context of the respective method were compared. Results: 18 patients had ST depression only in ergometry (group B), 23 had ST depression only during 24-h ABPM/ECG monitoring (group C) and 28 patients had ST depression with both methods (group D). Group A had no ST depression with any method. In group D, at the onset of ST depression with 24-h ABPM/ECG investigation, all parameters except diastolic blood pressure were signifi cantly lower compared with the corresponding parameters at the onset of ST depression with ergometry (systolic blood pressure: 148 ± 19 vers 188 ± 35 mmHg, p Ͻ 0.001; heart rate: 93 ± 12 vs 120 ± 21 beat/min, p Ͻ 0.0001; double product: 13,714 ± 2315 vs 22,992 ± 3,985 mmHg/min), p Ͻ 0.0001). Conclusion: ST depressions during everyday life detected by 24-h ABPM/ECG are characterized by a substantially lower triggering threshold for blood pressure level parameters compared with ergometry. The two methods detecting ischemia do not replace but complement each other.

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“…Another phenomenon observed with a high prevalence in hypertensive patients is ST depression detected by an analysis of the ST‐segment changes on a Holter‐electrocardiographic (ECG) monitor 5,6 . These can be triggered by variations of BP in the early morning and also have an unfavorable cardiovascular prognosis 7–13 . The objective of the present study in hypertensives was hence to investigate the predictive value of MS and dipping status of BP for ST‐segment depression and whether these parameters affect the circadian rhythmicity of ST‐segment depression episodes.…”

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confidence: 96%

Early Morning Surge and Dipping Status of Blood Pressure: Are These of Predictive Value for Silent Myocardial Ischemia?

Uen

Asghari

Nickenig

et al. 2009

J of Clinical Hypertension

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To investigate the predictive value of morning surge (MS) and dipping status of blood pressure (BP) for ST-segment depression (ST depression) in hypertensive persons, the combined 24-hour ambulatory BP measurement and Holter electrocardiographic recordings of 344 patients (132 women and 212 men, 60AE12 years) were analyzed. The morning BP surge was calculated as mean systolic BP during the 2 hours after awaking minus the mean systolic BP during the 1 hour that included the lowest sleep BP. Depending on the percentage decrease in systolic BP at night, patients were subdivided into extreme dippers, dippers, nondippers, and risers. ST depression was defined as horizontal or descending ST depression of 1 mm of 1 minute duration and a 1-minute interval after the previous episode or 24-hour mean ST-segment value <)0.1 mV. ST depression was observed in 76 (22.1%) of 344 patients. The mean MS in patients with ST depression was with 25AE15 mm Hg and not significantly different when compared with patients without ST depression (26AE15 mm Hg). The prevalence of ST depression was not significantly different in dippers, extreme dippers, nondippers, and risers (20%, 23.5%, 23%, and 25.5%, respectively). Systolic and diastolic BP values during ST depression were significantly higher in the morning as compared with ST depression in the evening (149 ⁄ 84 mm Hg vs 138 ⁄ 78 mm Hg, P<.05). In the present study, MS and dipping status of BP were not associated with ST depression. ST depression was, however, characterized by significantly higher BP peaks in the early morning hours.

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Fifteen-year risk of major coronary events predicted by Holter ST-monitoring in asymptomatic middle-aged men

Abstract: Holter monitoring can be used as a complement to conventional risk factor evaluation in deciding whether or not to treat risk factors for CHD in asymptomatic subjects.

Cited by 8 publications

References 39 publications

Myocardial Ischemia Induced by 5-Fluorouracil: A Prospective Electrocardiographic and Cardiac Biomarker Study

Myocardial Ischemia Induced by 5-Fluorouracil: A Prospective Electrocardiographic and Cardiac Biomarker Study

ST segment depression in hypertensive patients: A comparison of exercise test versus Holter ECG

Early Morning Surge and Dipping Status of Blood Pressure: Are These of Predictive Value for Silent Myocardial Ischemia?

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