Myocardial ischemia during daily activities and stress.
Myocardial ischemia during daily activities and stress.
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日常活动和压力期间心肌缺血。
DOI：
10.1016/0002-9149(86)90410-8
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发表时间：
1986
期刊：
影响因子：
--
通讯作者：
S. Stern
中科院分区：
文献类型：
--
作者：
D. Tzivoni;A. Gavish;J. Benhorin;A. Keren;S. Stern
210例患者在日常活动期间进行24小时双通道霍尔特监测;同一天还进行布鲁斯方案平板运动试验，并使用相同的霍尔特系统记录心电图。在97例患者的日常活动中观察到显著的ST段压低，而在122例患者的活动平板试验中记录到类似的变化。因此，77%的ST段压低患者在平板运动试验激发期间在日常生活中有缺血发作。另一方面，3例经证实患有严重冠状动脉疾病的患者在日常活动中发生自发性缺血发作，但负荷试验阴性。在日常活动期间的缺血性变化以低于负荷测试期间的心率发展（分别为94次/分钟vs 109次/分钟，p < 0.05）。在日常活动中共记录了351例缺血发作，其中241例（69%）无症状。在46例患者中，所有发作均为无症状，15例均为有症状，而在36例中，检测到有症状和无症状发作。有症状发作的平均持续时间为13.7分钟，无症状发作的平均持续时间为14.9分钟（差异不显著）。两组ST段压低程度相似。由于143例患者的冠状动脉病变较严重，因此进行了冠状动脉造影; 43例冠状动脉正常，100例冠状动脉病变。在这个选定的组中，霍尔特监测在日常活动期间的敏感性为87%，在应激期间为97%;在日常活动期间的特异性为95%，在应激期间为88%。这些数据支持使用霍尔特监测来评价日常活动中的缺血变化，并提示其在判断抗心绞痛治疗效果方面的潜在应用。
Twenty-four-hour, 2-channel Holter monitoring during daily activities was performed in 210 patients; during the same day a Bruce protocol treadmill test was also performed and the electrocardiogram was recorded using the same Holter system. Significant ST-segment depression was observed during daily activities in 97 patients, while similar changes were recorded during the treadmill test in 122 patients. Thus, 77% of patients with ST depression during the provocation of the treadmill test had ischemic episodes during their everyday life. On the other hand, 3 patients with proven significant coronary artery disease had spontaneous ischemic episodes during daily activities, but had a negative stress test. The ischemic changes during daily activity developed at a lower heart rate than during stress testing (94 beats/ min vs 109 beats/min, respectively, p < 0.05). A total of 351 ischemic episodes were recorded during daily activities, 241 (69%) of these were asymptomatic. In 46 patients all episodes were asymptomatic, in 15 all were symptomatic, while in 36 both symptomatic and silent episodes were detected. The mean duration of the symptomatic episodes was 13.7 minutes and that of the asymptomatic ones was 14.9 minutes (difference not significant). The degree of ST depression in these 2 groups was also similar. Because of more advanced symptomatology in 143 patients, coronary arteriography was performed; 43 had normal and 100 had pathologic coronary arteries. In this selected group, the sensitivity of Holter monitoring during daily activity was 87% and during stress 97%; the specificity during daily activity was 95% and during stress 88%. These data support the use of Holter monitoring for evaluating ischemic changes during daily activity and suggest its potential application for judging efficacy of antianginal therapy.