Scardi S, Pandullo C, Di Lenarda A, Poletti A
Centro Cardiovascolare, Ospedale Maggiore, Trieste.
G Ital Cardiol. 1992 Aug;22(8):931-9.
We studied the predictive value of prolonged angina perception threshold in identifying patients with stable coronary artery disease at risk of silent myocardial ischemia during daily life.
71 patients with documented coronary artery disease (previous myocardial infarction or stenotic lesion > 60% at angiography) underwent a symptom-limited exercise test and out-of-hospital Holter monitoring after drug withdrawal. A second exercise test was performed before disconnecting the dynamic EKG in order to validate the ST-depression recorded during ambulatory monitoring. 23 patients (32.4%) (Group A) had angina perception threshold > 60 sec after onset of ischemia (ST > 1 mm), while in 48 (67.7%) the delay in the perception of angina was shorter than 60 sec (Group B). The demographic, clinical and angiographic variables did not influence the angina perception threshold; however, this parameter was the most powerful predictor of ambulatory ischemia among the two groups (4.8 vs 2.8 p < 0.02), and in particular of the painless episodes (3.8 vs 1.8 p < 0.002). Moreover, the silent ischemic time was longer in patients of group A (4362 vs 1774 sec p < 0.017). Finally, the event-free survival was similar in the two groups of patients during the 2 years of follow-up (cardiac death 1 vs 3, nonfatal myocardial infarction 1 vs 1, aorto-coronary bypass 2 vs 7, PTCA 2 vs 2, unstable angina 0 vs 2), total events 6 vs 15 p = ns.
These results demonstrate that the patients at risk for silent ischemia during ambulatory monitoring may be identified simply by evaluating their angina perception threshold during exercise test; however, silent ischemia does not have an adverse prognostic value.
我们研究了延长的心绞痛感知阈值在识别日常生活中存在无症状心肌缺血风险的稳定型冠状动脉疾病患者方面的预测价值。
71例有冠状动脉疾病记录（既往心肌梗死或血管造影显示狭窄病变>60%）的患者在停药后接受了症状限制性运动试验和院外动态心电图监测。在断开动态心电图之前进行了第二次运动试验，以验证动态监测期间记录的ST段压低情况。23例患者（32.4%）（A组）在缺血发作（ST>1mm）后心绞痛感知阈值>60秒，而48例患者（67.7%）心绞痛感知延迟短于60秒（B组）。人口统计学、临床和血管造影变量均不影响心绞痛感知阈值；然而，该参数是两组患者动态缺血的最有力预测指标（4.8对2.8，p<0.02），尤其是无痛发作（3.8对1.8，p<0.002）。此外，A组患者的无症状缺血时间更长（4362对1774秒，p<0.017）。最后，在2年的随访期间，两组患者的无事件生存率相似（心源性死亡1例对3例，非致命性心肌梗死1例对1例，主动脉冠状动脉搭桥术2例对7例，经皮冠状动脉腔内血管成形术2例对2例，不稳定型心绞痛0例对2例），总事件数6例对15例，p=无统计学意义。
这些结果表明，通过评估运动试验期间的心绞痛感知阈值可以简单地识别动态监测期间有无症状缺血风险的患者；然而，无症状缺血不具有不良预后价值。
