Deanfield J E, Shea M, Ribiero P, de Landsheere C M, Wilson R A, Horlock P, Selwyn A P
Am J Cardiol. 1984 Dec 1;54(10):1195-200. doi: 10.1016/s0002-9149(84)80066-1.
Patients with angina and coronary artery disease (CAD) have many episodes of transient ST-segment depression during ordinary daily life, and these are often asymptomatic. To investigate this signal as a marker of myocardial ischemia, 30 patients with chronic stable angina and CAD underwent positron tomography, recording the regional myocardial uptake of rubidium-82, pain and ST-segment changes before, during and after 59 technically satisfactory exercise tests, 35 cold pressor tests and 22 episodes of unprovoked ST depression. Exercise resulted in 53 episodes of ST depression with angina and in 5 episodes without pain. After cold pressor tests, there were 3 episodes of ST depression and pain and 12 of painless ST depression. Only 9 episodes of unprovoked ST depression were accompanied by pain. Tomography showed independent evidence of ischemia in 63 (97%) of the total 65 episodes of ST depression with angina and in all 30 episodes of painless ST depression. In each patient perfusion defects occurred in the same myocardial segment during painful and painless ST depression and responses were significantly different from those in 16 normal subjects studied in the same way. These findings support the use of transient ST depression in continuous monitoring to assess the activity of CAD, but only in patients with typical angina pectoris, ST depression during exercise and proved CAD. They strengthen the evidence derived from ambulatory monitoring for a wider picture of the disease than is generally appreciated, with more frequent episodes of silent myocardial ischemia than of angina pectoris.
患有心绞痛和冠状动脉疾病（CAD）的患者在日常生活中会出现多次短暂性ST段压低，且这些情况通常无症状。为了研究这种信号作为心肌缺血的标志物，30例慢性稳定型心绞痛和CAD患者接受了正电子断层扫描，记录了在59次技术上令人满意的运动试验、35次冷加压试验和22次自发性ST段压低之前、期间和之后的局部心肌对铷-82的摄取、疼痛及ST段变化。运动导致53次伴有心绞痛的ST段压低发作和5次无疼痛的发作。冷加压试验后，有3次ST段压低伴疼痛发作和12次无痛性ST段压低发作。仅9次自发性ST段压低发作伴有疼痛。断层扫描显示，在65次伴有心绞痛的ST段压低发作中的63次（97%）以及所有30次无痛性ST段压低发作中，均有独立的心肌缺血证据。在每个患者中，疼痛性和无痛性ST段压低发作时，灌注缺损出现在相同的心肌节段，且反应与以相同方式研究的16名正常受试者的反应显著不同。这些发现支持在连续监测中使用短暂性ST段压低来评估CAD的活动情况，但仅适用于患有典型心绞痛、运动时出现ST段压低且已确诊CAD的患者。它们强化了动态监测所获得的证据，表明该疾病的情况比一般认识的更为广泛，无症状心肌缺血发作比心绞痛更为频繁。
