Moczurad K W, Dubiel J P, Grodecki J K, Curyło A M
Przegl Lek. 1989;46(3):350-5.
In a group of 17 men and women aged 38-65 years (means = 51.1) three months after the first myocardial infarction we studied changes in silent ischemic ST segment depression by using Holter monitoring and exercise stress testing before and after 120 mg/daily of oral isosorbide dinitrate (Isoket). Repeated ECG monitoring and exercise stress test were performed after two weeks. It was found that before isosorbide dinitrate therapy 16 out of 17 patients had 56 episodes of ST segment depression of 1-5 mm including 6 (37.5%) symptomatic episodes and 10 (62.5%) asymptomatic episodes. The number of asymptomatic episodes after isosorbide dinitrate therapy decreased more than five times (p less than 0.001), their duration was three times shorter (p less than 0.01). ST segment depressions were also significantly smaller. During isosorbide dinitrate therapy the duration of stress test was almost doubled and the achievable heart rate increased (p less than 0.02; p less than 0.05). The magnitude of ST segment depression during exercise testing also decreased significantly (p less than 0.01) and at heart rate below 100 beats/min ischemic ST segment depression were not observed, in contrast to pre-treatment period. Thus it may be concluded that silent myocardial ischemia is a frequent event in patients after the first myocardial infarction and isosorbide dinitrate significantly decreases the number of symptomatic and asymptomatic episodes detected by Holter monitoring.
在17名年龄在38 - 65岁（平均年龄 = 51.1岁）的男性和女性中，在首次心肌梗死后三个月，我们通过动态心电图监测以及口服硝酸异山梨酯（异舒吉）120mg/日前后的运动负荷试验，研究了无症状性缺血性ST段压低的变化情况。两周后进行了重复心电图监测和运动负荷试验。结果发现，在硝酸异山梨酯治疗前，17名患者中有16名出现了56次ST段压低1 - 5mm的情况，其中6次（37.5%）有症状发作，10次（62.5%）无症状发作。硝酸异山梨酯治疗后无症状发作次数减少了超过五倍（p < 0.001），发作持续时间缩短了三倍（p < 0.01）。ST段压低情况也显著减轻。在硝酸异山梨酯治疗期间，运动负荷试验的持续时间几乎翻倍，可达到的心率增加（p < 0.02；p < 0.05）。运动试验期间ST段压低的幅度也显著降低（p < 0.01），与治疗前相比，心率低于100次/分钟时未观察到缺血性ST段压低。因此可以得出结论，无症状性心肌缺血在首次心肌梗死后的患者中是常见事件，硝酸异山梨酯显著减少了动态心电图监测检测到的有症状和无症状发作次数。
