Boon Diederik, van Goudoever Jeroen, Piek Jan J, van Montfrans Gert A
Department of Internal Medicine, Room C2-432, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, PO Box 22660, 1100 DE Amsterdam, The Netherlands.
Hypertension. 2003 Mar;41(3):476-81. doi: 10.1161/01.HYP.0000054980.69529.14. Epub 2003 Feb 10.
The reported prevalence of silent cardiac ischemia as assessed by ambulatory electrocardiographic recording varies widely. The influence of the stringency of the analysis criteria has never been reported. We performed 24-hour, 12-lead ambulatory electrocardiographic recording in patients with hypertension but without proven coronary artery disease. The recordings were analyzed according to strict ST segment depression criteria adapted from the American College of Cardiology/American Heart Association guidelines and according to basic ST segment depression criteria adapted from studies with only concise descriptions of ambulatory electrocardiographic recording analysis. Also, we performed 24-hour ambulatory blood pressure monitoring. More than 4400 hours of ambulatory electrocardiographic recording and ambulatory blood pressure monitoring in 194 patients with hypertension were analyzed. Medication was withdrawn in 45% of the patients. The average systolic blood pressure during the day was 152+/-13 (mean+/-SD); diastolic blood pressure was 94+/-17 mm Hg. According to the basic ST segment depression criteria, we found a prevalence of silent ischemia of 11.3%, and with the strict criteria the prevalence was 5.2%. The patients who were considered positive according to the basic criteria but not according to the strict criteria (false-positive) in the majority of cases (58%) had depression of an elevated baseline ST segment. We found a lower prevalence of silent cardiac ischemia as assessed by ambulatory electrocardiographic recording than generally reported. The stringency of applied analysis criteria appear to play an important role in this outcome.
通过动态心电图记录评估的无症状性心肌缺血的报告患病率差异很大。分析标准的严格程度的影响从未有过报道。我们对高血压但无冠状动脉疾病确诊的患者进行了24小时12导联动态心电图记录。记录根据美国心脏病学会/美国心脏协会指南改编的严格ST段压低标准以及仅对动态心电图记录分析有简要描述的研究改编的基本ST段压低标准进行分析。此外，我们还进行了24小时动态血压监测。对194例高血压患者超过4400小时的动态心电图记录和动态血压监测进行了分析。45%的患者停用了药物。白天平均收缩压为152±13（均值±标准差）；舒张压为94±17mmHg。根据基本ST段压低标准，我们发现无症状性心肌缺血的患病率为11.3%，而严格标准下患病率为5.2%。大多数病例（58%）中，根据基本标准被认为阳性但根据严格标准不被认为阳性（假阳性）的患者基线ST段抬高有压低情况。我们发现通过动态心电图记录评估的无症状性心肌缺血患病率低于一般报道。所应用分析标准的严格程度似乎在这一结果中起重要作用。
