SUBSETS OF AMBULATORY MYOCARDIAL-ISCHEMIA BASED ON HEART-RATE ACTIVITY - CIRCADIAN DISTRIBUTION AND RESPONSE TO ANTIISCHEMIC MEDICATION
SUBSETS OF AMBULATORY MYOCARDIAL-ISCHEMIA BASED ON HEART-RATE ACTIVITY - CIRCADIAN DISTRIBUTION AND RESPONSE TO ANTIISCHEMIC MEDICATION
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DOI：
10.1161/01.cir.88.1.92
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发表时间：
1993-07-01
期刊：
影响因子：
37.8
通讯作者：
STONE, PH
中科院分区：
文献类型：
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作者：
ANDREWS, TC;FENTON, T;STONE, PH
背景在稳定型冠状动脉疾病患者中，确定动态缺血发作是否是由心肌需氧量增加或发作性冠状动脉血管收缩引起的，这对于指导最佳抗缺血治疗的选择和深入了解不良心脏事件的机制可能是重要的。在一项随机、双盲、交叉试验中，测定了50例接受普萘洛尔、地尔硫卓、硝苯地平或安慰剂治疗的患者在动态心电图（AECG）监测期间的平均分钟心率活动。在每次48小时AECG记录中，确定了各种幅度和持续时间的心率增加期，以及从每种治疗的各种基线心率开始的心率增加期，并确定了这些时间段与缺血发作相关的比例。分析了缺血发作的昼夜变化，根据心率是否增加进行分类。81%的缺血发作之前，心率增加大于或等于5次/分钟。发生与心率增加相关的缺血的可能性与心率增加的幅度和持续时间以及心率增加前的基线心率成正比：当心率增加5-9次/分钟并持续
Background. Identification of whether episodes of ambulatory ischemia are caused by increases in myocardial oxygen demand or to episodic coronary vasoconstriction in patients with stable coronary disease may be important to guide selection of optimal anti-ischemic therapy and to gain insight into mechanisms responsible for adverse cardiac events.Methods and Results. Mean minute heart rate activity during ambulatory ECG (AECG) monitoring was determined for 50 patients treated with propranolol, diltiazem, nifedipine, or placebo in a randomized, double-blind, crossover trial. Periods of heart rate increases of various magnitudes and durations and starting at various baseline heart rates on each therapy were identified throughout each 48-hour AECG recording, and the proportion of these periods associated with an ischemic episode was determined. The circadian variation of ischemic episodes categorized by the presence or absence of an increase in heart rate was analyzed. Eighty-one percent of ischemic episodes were preceded by an increase in heart rate greater-than-or-equal-to 5 beats per minute. The likelihood of developing ischemia associated with a heart rate increase was proportional to the magnitude and duration of the heart rate increase and the baseline heart rate before the increases in heart rate: likelihood ranged from 4% when the heart rate increased 5-9 beats per minute and lasted