Moczurad K W, Grodecki J K, Dubiel J P, Curyło A M
Kardiol Pol. 1989;32 Suppl 2:17-24.
Twenty-six men and women, aged 36-65 years, were studied 8-12 weeks after the first myocardial infarction with regard to silent ischemic ST-segment depression and heart rate by using 24-hour ambulatory electrocardiography and bicycle exercise testing. In 22 patients ambulatory ST-segment recordings revealed 81 episodes of ST-segment depression, including 34 (41.9%) painful and 47 (58.1%) painless episodes. Mean maximal ST-segment depression during symptomatic and asymptomatic episodes was 3.6 +/- 1.0 mm and 2.4 +/- 1.1 mm, respectively (p less than 0.02). Painless episodes most frequently occurred between 06.00 a.m. and 12.00 a.m. Ambulatory monitoring revealed a twofold increase in painful episodes at heart rate below 100 beats/min, whereas at heart rate above 125/min painless episodes were more frequent. Exercise testing showed a sevenfold increased incidence of ST-segment depression also at heart rate above 125 beats/min. In conclusion, silent myocardial ischemia is a frequent event in patients shortly after the first myocardial infarction, and painless episodes occur particularly frequently at high heart rates. Episodes of silent ischemia are found more frequently during ambulatory ECG monitoring than exercise testing. Studies on silent myocardial ischemia may be particularly relevant in the detection of the risk of myocardial infarction.
26名年龄在36至65岁之间的男性和女性，在首次心肌梗死后8至12周接受了研究，通过24小时动态心电图和自行车运动试验来观察无症状性缺血性ST段压低和心率情况。在22例患者中，动态ST段记录显示有81次ST段压低发作，其中34次（41.9%）伴有疼痛，47次（58.1%）无疼痛。有症状发作和无症状发作期间的平均最大ST段压低分别为3.6±1.0毫米和2.4±1.1毫米（p<0.02）。无痛发作最常发生在上午6点至中午12点之间。动态监测显示，心率低于100次/分钟时，疼痛发作增加两倍，而心率高于125次/分钟时，无痛发作更为频繁。运动试验显示，心率高于125次/分钟时，ST段压低的发生率也增加了7倍。总之，无症状性心肌缺血在首次心肌梗死后不久的患者中很常见，无痛发作在高心率时尤其频繁。动态心电图监测比运动试验更频繁地发现无症状性缺血发作。关于无症状性心肌缺血的研究可能对检测心肌梗死风险特别有意义。
