Tzivoni D, Gavish A, Benhorin J, Banai S, Keren A, Stern S
Heiden Department of Cardiology, Bikur Cholim Hospital, Jerusalem, Israel.
Am J Cardiol. 1987 Nov 1;60(13):1003-5. doi: 10.1016/0002-9149(87)90341-9.
Twenty patients with chronic stable angina pectoris, proved coronary artery disease, positive treadmill stress test response, and at least 2 episodes of ischemia per day underwent 72 hours of Holter monitoring during daily activities. During this period they had 389 ischemic episodes: 104 (27%) symptomatic and 285 (73%) silent. Marked variability was observed between patients in the number of ischemic episodes (range 2 to 15 per day, mean 6.5), duration of ischemia (range 6 to 419 minutes/day, mean 76.5), maximal ST depression (range 1 to 6 mm, mean 3.4) and heart rate at the beginning of ST depression (range 75 to 105 beat/min, mean 91). The day-to-day variability in individual patients between the different days in the number of ischemic episodes was 36%, in duration 51%, and in maximal degree of ST depression 31%. Only 9% variability was noted in heart rate at the beginning of ST depression. Similar day-to-day variability in individual patients was noted in the symptomatic and silent episodes. For clinical purposes of evaluation of ischemia during daily activities, 1 day of monitoring appears to be sufficient because within the first day, 78% of the maximal number of ischemic episodes, 64% of their duration, and 84% of the maximal degree of ST depression were detected. However, for evaluation of anti-ischemic drugs at least 2 monitoring days are required.
20例慢性稳定型心绞痛患者，经证实患有冠状动脉疾病，平板运动试验应激反应阳性，且每天至少有2次缺血发作，在日常活动期间接受了72小时的动态心电图监测。在此期间，他们共有389次缺血发作：104次（27%）有症状，285次（73%）无症状。观察到患者之间在缺血发作次数（每天2至15次，平均6.5次）、缺血持续时间（每天6至419分钟，平均76.5分钟）、最大ST段压低（1至6毫米，平均3.4毫米）以及ST段压低开始时的心率（75至105次/分钟，平均91次）方面存在显著差异。个体患者不同日期之间缺血发作次数的每日变异性为36%，持续时间为51%，最大ST段压低程度为31%。ST段压低开始时的心率变异性仅为9%。在有症状和无症状发作中也观察到个体患者类似的每日变异性。出于评估日常活动期间缺血情况的临床目的，1天的监测似乎就足够了，因为在第一天内，检测到了缺血发作最大次数的78%、发作持续时间的64%以及最大ST段压低程度的84%。然而，为了评估抗缺血药物，至少需要2天的监测。
