Cohn P F, Lawson W E
Am J Cardiol. 1987 Apr 1;59(8):746-9. doi: 10.1016/0002-9149(87)91085-x.
Ambulatory electrocardiographic monitoring is useful in documenting characteristics of both painful and silent myocardial ischemia occurring during out-of-hospital activities in patients with angina and coronary artery disease (CAD), but few data are available concerning silent myocardial ischemia during ambulatory electrocardiographic monitoring in asymptomatic patients with CAD. Accordingly, 480 hours of ambulatory electrocardiographic monitoring were recorded in 10 asymptomatic patients with CAD not receiving cardiac drugs (48 hours/patient). All 10 patients had silent myocardial ischemia on treadmill exercise testing, with initial ST-segment depression at 2 to 6 minutes in 7 patients and more than 6 minutes in 3 patients. During ambulatory electrocardiographic monitoring, 64 episodes of silent myocardial ischemia (1 mm of ST-segment depression for at least 1 minute) were recorded, ranging from 1 to 17 episodes/patient/48 hours. Of the 64 silent myocardial ischemic episodes, 30 (47%) occurred between 6 am and noon. Duration of silent myocardial ischemia was 798 minutes (range 1 to 80). ST-segment depression ranged from 1 to 4.5 mm. Heart rate at onset of the episodes on ambulatory electrocardiographic monitoring ranged from 65 to 150 beats/min (mean 98), which was significantly less than that during treadmill exercise testing in the same patients (mean 120). At cardiac catheterization, 7 patients had 2- or 3-vessel CAD and 3 had 1-vessel CAD. Thus, silent myocardial ischemia is common during daily life in asymptomatic CAD patients with positive treadmill exercise tests.
动态心电图监测对于记录心绞痛和冠心病（CAD）患者院外活动期间发生的疼痛性和无症状性心肌缺血的特征很有用，但关于无症状CAD患者动态心电图监测期间无症状性心肌缺血的数据很少。因此，对10名未接受心脏药物治疗的无症状CAD患者进行了480小时的动态心电图监测（每位患者48小时）。所有10名患者在平板运动试验中均有无症状性心肌缺血，7名患者在2至6分钟时出现初始ST段压低，3名患者在6分钟以上出现初始ST段压低。在动态心电图监测期间，记录到64次无症状性心肌缺血发作（ST段压低≥1mm至少持续1分钟），每位患者每48小时发作1至17次。在这64次无症状性心肌缺血发作中，30次（47%）发生在上午6点至中午之间。无症状性心肌缺血的持续时间为798分钟（范围1至80分钟）。ST段压低范围为1至4.5mm。动态心电图监测发作开始时的心率范围为65至150次/分钟（平均98次/分钟），明显低于同一患者平板运动试验期间的心率（平均120次/分钟）。在心脏导管检查中，7名患者有2支或3支血管病变，3名患者有单支血管病变。因此，如果无症状CAD患者平板运动试验呈阳性，无症状性心肌缺血在日常生活中很常见。
