Lichtlen P R
Division of Cardiology, Hannover Medical School, Germany.
Eur Heart J. 1996 Dec;17 Suppl G:38-47. doi: 10.1093/eurheartj/17.suppl_g.38.
Quantification of spontaneous ischaemic episodes during daily activities has been made possible by the introduction of continuous ambulatory ECG (Holter) monitoring. In view of the fact that the large majority of ischaemic patients exhibit both painful and silent myocardial ischaemia, the concept of the total ischaemic burden has been developed. This takes account of the total number, duration and extent of ischaemic episodes over 24 h, in order to provide an assessment of the severity of patients' ischaemic heart disease. Although it is uncertain whether patients with positive exercise tests and both silent and symptomatic ischaemic episodes have a higher risk for myocardial infarction, several studies have shown that these patients have a higher total ischaemic burden. In contrast, despite having high-grade stenosis and positive exercise tests, patients with only silent ischaemic episodes, or without ischaemic episodes during continuous monitoring, seem to experience lower mortality. In general, prognosis is not determined by the presence or absence of absence of anginal pain but by the amount of ischaemia.
通过引入连续动态心电图（Holter）监测，使得在日常活动期间对自发性缺血发作进行量化成为可能。鉴于绝大多数缺血性患者同时表现出疼痛性和无症状性心肌缺血，因此提出了总缺血负荷的概念。这考虑了24小时内缺血发作的总数、持续时间和范围，以便对患者缺血性心脏病的严重程度进行评估。尽管运动试验阳性且有无症状和有症状缺血发作的患者发生心肌梗死的风险是否更高尚不确定，但多项研究表明这些患者的总缺血负荷更高。相比之下，尽管存在严重狭窄且运动试验阳性，但仅有无症状缺血发作或在连续监测期间无缺血发作的患者，其死亡率似乎较低。一般而言，预后并非取决于心绞痛的有无，而是取决于缺血的程度。
