Caussé C, Allaert F A, Marcantoni J P, Wolf J E
Laboratoires Pierre Fabre cardiovasculaire, Castres.
Arch Mal Coeur Vaiss. 2001 Aug;94(8):779-84.
To determine in standard living conditions the circadian variation of the symptomatic and silent electrocardiographic ischaemia in patients with chronic stable coronary insufficiency. To evaluate the influence of the past history of the patients on the circadian variations of the symptomatic and silent ischaemic events.
The patients included in the study presented with stable angina pectoris and have undergone a 96 hours Ambulatory ECG (AECG) monitoring with a low-weight and compact material which did not modify their daily activities (R-test). The system records the trace that the patient has initiated it himself following the onset of symptoms and makes possible to distinguish between silent and symptomatic ischaemia. The same experienced cardiologist validated all the AECG records.
1,022 patients aged 64.6 +/- 11.0 years suffering of coronary insufficiency from 5.8 +/- 6.0 years have undergone an electrocardiographic record by an R-test for a total duration of 95,725 hours. Of the 1,022 records, 3,258 ischaemic events have been validated: 295 (9.1%) were symptomatic and 2,963 (90.9%) were silent which correspond to a ratio of 1 versus 9 while this ratio is usually described as 1 versus 4. By 26.5% (n = 271) of the patients, ischaemia have been detected and among them more than a half (54.6%, n = 148) were presenting only silent ischaemia. Of these patients who present silent ischaemia, it was recorded during the first 24 hours by only 63.7% of them which is the usual duration of an ambulatory ECG monitoring. This percentage increases to 83.1% after 48 hours and to 94.1% after 72 hours.
By more than one third (36.3%) of the patients with stable coronary insufficiency, an ambulatory ECG monitoring recorded during only 24 hours is insufficient to detect a silent ischaemia which will happen later. A record duration of 48 hours reduces this risk to 20% of the patients and of 72 hours to less than 5%.
确定在标准生活条件下慢性稳定型冠状动脉供血不足患者有症状和无症状心电图缺血的昼夜变化。评估患者既往病史对有症状和无症状缺血事件昼夜变化的影响。
纳入研究的患者表现为稳定型心绞痛，使用不影响其日常活动的低重量紧凑型设备进行了96小时动态心电图（AECG）监测（R-测试）。该系统记录患者在症状发作后自行启动的心电图轨迹，能够区分无症状和有症状缺血。同一位经验丰富的心脏病专家对所有AECG记录进行了验证。
1022例年龄为64.6±11.0岁、患有冠状动脉供血不足5.8±6.0年的患者通过R-测试进行了心电图记录，总时长为95725小时。在1022份记录中，3258次缺血事件得到验证：295次（9.1%）有症状，2963次（90.9%）无症状，对应比例为1比9，而通常描述的比例为1比4。26.5%（n = 271）的患者检测到缺血，其中一半以上（54.6%，n = 148）仅表现为无症状缺血。在这些出现无症状缺血的患者中，仅63.7%在最初24小时内记录到，这是动态心电图监测的通常时长。48小时后该百分比增至83.1%，72小时后增至94.1%。
超过三分之一（36.3%）的稳定型冠状动脉供血不足患者，仅24小时的动态心电图监测不足以检测到随后发生的无症状缺血。记录时长48小时可将此风险降低至20%的患者，72小时则降至不到5%。
