连续心电图（动态心电图或 Holter）监测 ST 段评估缺血的临床意义：综述。
The clinical significance of continuous ECG (ambulatory ECG or Holter) monitoring of the ST-segment to evaluate ischemia: a review.
机构信息
Division of Cardiovascular Medicine, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
出版信息
Prog Cardiovasc Dis. 2013 Sep-Oct;56(2):195-202. doi: 10.1016/j.pcad.2013.07.001. Epub 2013 Aug 16.
Abstract
Silent ischemia is a common manifestation of coronary artery disease (CAD). Continuous ECG (cECG) monitoring is an effective tool for assessing the frequency and duration of silent ischemic episodes for patients with CAD and for risk stratifying asymptomatic patients or those after an acute coronary syndrome by identifying those at increased risk for future cardiovascular events or death. cECG also allows monitoring of the effectiveness of therapy in patients with CAD. Treatment strategies targeted toward the elimination of silent ischemia have shown that revascularization was better than medical therapy in eliminating silent ischemia, but large scale, prospective studies targeting silent ischemia as a treatment endpoint are still lacking. Future research is warranted to study the effects of newer medical agents or the selected use of revascularization in those patients with persistent silent ischemia despite current medical regiments.
摘要
无症状性心肌缺血是冠状动脉疾病（CAD）的常见表现。连续心电图（cECG）监测是评估 CAD 患者无症状性心肌缺血发作的频率和持续时间的有效工具，通过识别那些未来发生心血管事件或死亡风险增加的患者，对无症状患者或急性冠状动脉综合征患者进行风险分层。cECG 还可以监测 CAD 患者治疗的效果。针对消除无症状性心肌缺血的治疗策略表明，血管重建优于药物治疗，可以消除无症状性心肌缺血，但仍缺乏针对无症状性心肌缺血作为治疗终点的大规模前瞻性研究。未来的研究需要研究新型药物或在那些尽管采用当前药物治疗方案但仍持续存在无症状性心肌缺血的患者中选择性使用血管重建的效果。
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2
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3
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4
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Am J Cardiol. 2009 Jul 1;104(1):36-40. doi: 10.1016/j.amjcard.2009.02.044. Epub 2009 May 4.
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J Am Coll Cardiol. 2009 Apr 21;53(16):1411-21. doi: 10.1016/j.jacc.2008.12.053.
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