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Abstract
Holter monitoring of ST-segment changes is a unique method of studying the character
of transient myocardial ischemia that occurs during ordinary daily life. The electrocardiographic
signal is a reliable marker of ischemia in defined populations of patients with angina
and coronary disease, but should be interpreted with caution outside of these groups.
Detailed studies in patients with chronic stable angina have shown that transient
ischemia is frequently silent and prolonged, and may occur without evidence of physical
exertion. Analysis of underlying changes in regional myocardial perfusion using rubidium-82
and positron tomography has shown that a decrease in myocardial perfusion (supply)
is involved in the genesis of many episodes of ischemia during daily life. Clinical
trials have shown that drugs that affect demand and supply are efficacious against
both painful and painless ischemia and that combinations of agents can provide useful
benefits. There is, however, marked natural variability in disease activity despite
“stable” symptoms, which must be taken into account in individual patient assessment
and the rational design of clinical trials. Ambulatory monitoring permits quantitation
of previously unrecognized myocardial ischemia, and treatment can thus be assessed
in terms of ischemic activity during everyday life rather than on data obtained during
brief hospital visits. An active approach to the detection and monitoring of transient
ischemia with and without pain will be necessary if prospective clinical research
shows that treatment of silent myocardial ischemia can prevent myocardial damage and
improve prognosis.
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References
- Myocardial ischaemia during daily life in patients with stable angina: its relation to symptoms and heart rate changes.Lancet. 1983; 2: 753-758
- Early detection of silent ischaemic heart disease by 24-hour electrocardiographic monitoring of active subjects.Br Heart J. 1974; 36: 481-486
- Active transient myocardial ischemia during daily life in asymptomatic patients with positive exercise tests and coronary disease.Am J Cardiol. 1986; 57: 1010-1016
- Exercise-induced ischemia in mildly symptomatic patients with coronary-artery disease and preserved left ventricular function. Identification of subgroups at risk of death during medical therapy.N Engl J Med. 1984; 311: 1339-1345
- Exercise electrocardiogram and coronary heart disease mortality in the Multiple Risk Factor Intervention Trial.Am J Cardiol. 1985; 55: 16-24
- Impairment of myocardial perfusion and function during painless myocardial ischemia.JACC. 1983; 1: 924-930
- “Silent” myocardial ischemia during and after exercise testing in patients with coronary artery disease.Am Heart J. 1978; 95: 441-447
- Frequency response characteristics of ambulatory ECG monitoring systems and their implications for ST segment analysis.Am Heart J. 1982; 103: 20-31
- Computer system for analysis of ST segment changes on 24 hour Holter monitor tapes: comparison with other available systems.JACC. 1984; 4: 245-252
- Validation of a device for ambulatory monitoring and on-line analysis of ischemia in patients with angina (abstr).JACC. 1986; 17: 239A
- Prevalence and magnitude of S-T segment and T wave abnormalities in normal men during continuous ambulatory electrocardiography.Am J Cardiol. 1982; 49: 1638-1642
- Ambulatory electrocardiographic ST segment changes in healthy volunteers.Br Heart J. 1983; 50: 460-464
- Analysis of ST-segment changes in normal subjects: implications for ambulatory monitoring in angina pectoris.Am J Cardiol. 1984; 54: 1321-1325
- Transient ST-segment depression as a marker of myocardial ischemia during daily life.Am J Cardiol. 1984; 54: 1195-1200
- Incidence and prognosis of unrecognized myocardial infarction: an update on the Framingham Study.N Engl J Med. 1984; 311: 1144-1147
- Silent ischemia as a marker for early unfavorable outcomes in patients with unstable angina.N Engl J Med. 1986; 314: 1214-1219
- Ischemic ST-segment changes by ambulatory Holter predict one year mortality in high risk post infarct patients (abstr).Circulation. 1986; 74: II-58
- Clinical evaluation of transient myocardial ischemia during daily life.Am J Med. 1985; 79: 18-24
- Transient asymptomatic ST-segment depression during daily activity.Am J Cardiol. 1977; 39: 396-402
- Effects of combined alpha and beta adrenoceptor blockade in patients with angina pectoris: a double-blind study comparing labetalol with placebo.Br Heart J. 1985; 53: 47-52
- Different mechanisms for the relief of angina after coronary artery bypass surgery: physiological versus anatomical assessment.Br Heart J. 1984; 52: 502-509
- Role of heart rate in pathophysiology of chronic stable angina.Lancet. 1984; 2: 1353-1357
- Character and causes of transient myocardial ischemia during daily life. Implications for treatment of patients with coronary disease.Am J Med. 1986; 80: 18-24
- Different pathophysiology of painful and silent myocardial ischemia (abstr).Circulation. 1986; 74: II-57
- Objective assessment of antianginal treatment: a double-blind comparison of propranolol, nifedipine, and their combination.Br Med J. 1980; 281: 184-187
- Circadian variation in the frequency of onset of acute myocardial infarction.N Engl J Med. 1985; 313: 1315-1322
- Variability of “stable angina” revealed by ST Holter monitoring: implications for clinical investigation (abstr).Circulation. 1986; 74: II-400
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© 1987 Published by Elsevier Inc.
