Clinical implications of silent versus symptomatic exercise-induced myocardial ischemia in patients with stable coronary disease.
Clinical implications of silent versus symptomatic exercise-induced myocardial ischemia in patients with stable coronary disease.
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稳定型冠心病患者无症状运动引起的心肌缺血与有症状运动引起的心肌缺血的临床意义。
DOI：
10.1016/s0735-1097(96)00585-2
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发表时间：
1997
影响因子：
24
通讯作者：
Hall,WJ
中科院分区：
文献类型：
--
作者：
Narins,CR;Zareba,W;Moss,AJ;Goldstein,RE;Hall,WJ
目标.本研究旨在更好地了解无症状性脑缺血相对于有症状性脑缺血的功能和预后意义。先前的研究得出了相互矛盾的结论，即在无创心脏检查中发现的无痛性缺血是否与心肌缺血程度较轻或与缺血伴心绞痛或两者兼而有之的预后不同有关。936例急性冠状动脉事件（心肌梗死或不稳定型心绞痛）后1至6个月临床稳定的患者接受了动态监测、运动平板试验和负荷铊-201放射性造影。然后对他们进行平均23个月的前瞻性随访，以了解复发性心脏事件（心源性死亡、非致命性心肌梗死或不稳定型心绞痛）。与试验期间有症状性缺血的患者（n = 125）相比，无症状性缺血患者（n = 378）在负荷铊造影中表现出较轻的严重性和广泛的可逆性缺陷（p = 0.0008），跑步机测试期间的功能损伤较少，表现为运动持续时间较长（640 ± 173 vs. 529 ± 190 s，p = 0.002）和更长的ST段压低时间（530 ± 215 vs. 419 ± 205 s，p = 0.0001），以及在动态监测期间更少发生ST段压低（9% vs. 19%，p = 0.005）。与无症状（18.0%）或无缺血（17.3%）的患者相比，有症状缺血的患者随后复发心脏事件的数量（28.8%）显着增加（p = 0.004）。不良结局尤其集中在有症状的缺血和运动耐量差的亚组中。通过考克斯回归分析校正基线临床特征后，无症状性与有症状性缺血患者之间心脏事件发生率的差异仍然存在。在冠脉事件恢复后1 - 6个月的运动试验中，无痛性缺血的患者比症状性缺血的患者缺血性心肌损害更少，心脏事件复发更少。（美国科尔心脏病学杂志1997;29：756-63）
Objectives. This study was undertaken to better understand the functional and prognostic significance of silent relative to symptomatic ischemia.Background. Previous studies have reached conflicting conclusions as to whether painless ischemia identified during noninvasive cardiac testing is related to a lesser extent of myocardial ischemia or a different prognosis than ischemia accompanied by angina, or both.Methods. Nine hundred thirty-six clinically stable patients 1 to 6 months after an acute coronary event, either myocardial infarction or unstable angina, underwent ambulatory monitoring, exercise treadmill testing and stress thallium-201 scintigraphy. They were then followed up prospectively for a mean of 23 months for recurrent cardiac events (cardiac death, nonfatal myocardial infarction or unstable angina).Results. Compared with patients with symptomatic ischemia during testing (n = 125), those with silent ischemia (n = 378) demonstrated less severe and extensive reversible defects on stress thallium scintigraphy (p = 0.0008), less functional impairment during treadmill testing manifested by longer exercise duration (640 ± 173 vs. 529 ± 190 s, p = 0.002) and longer time to ST segment depression (530 ± 215 vs. 419 ± 205 s, p = 0.0001) and less frequent ST segment depression during ambulatory monitoring (9% vs. 19%, p = 0.005). Patients with symptomatic ischemia had a significantly (p = 0.004) increased number of subsequent recurrent cardiac events (28.8%) versus those with silent (18.0%) or no (17.3%) ischemia. Adverse outcomes were especially concentrated in the subgroup with symptomatic ischemia and poor exercise tolerance. The difference in cardiac event rates between patients with silent versus symptomatic ischemia persisted after adjustment for baseline clinical characteristics by Cox regression analysis.Conclusions. Patients with painless ischemia during exercise testing 1 to 6 months after recovery from a coronary event have less jeopardized ischemic myocardium and fewer recurrent cardiac events than patients with symptomatic ischemia.(J Am Coll Cardiol 1997;29:756–63)
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影响因子：
4.9
作者：
F. Wackers;R. Fetterman;J. Mattera;J. Clements
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J. Clements
影响因子：
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作者：
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ANDERSON, KO
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DOI：
10.1016/0002-9149(91)90316-d
发表时间：
1991
期刊：
The American journal of cardiology
影响因子：
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作者：
M. Travin;A. R. Flores;C. Boucher;J. Newell;P. Laraia
通讯作者：
P. Laraia
“无症状”心肌缺血真的和症状性缺血一样严重吗？
影响因子：
37.8
作者：
J. Klein;S. Chao;D. Berman;A. Rozanski
通讯作者：
A. Rozanski