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Introduction: Silent myocardial ischemia is definedas objective evidence of myocardial ischemia withoutangina or angina equivalent. In Framingham study, 30% ofmyocardial infarcts were silent, diagnosed only by serialelectrocardiography. There is increasing evidence thatasymptomatic myocardial infarctions and silent ischemiaoccur more frequently in diabetic patients. So present studywas done to record the prevalence of silent myocardialischemia in asymptomatic patients of type 2 diabetes mellitus.Material and methods: The present study was a crosssectional study, carried out among 88 randomly selectedpatients of type 2 diabetes mellitus for more than 1 year,patients >18 years of age, who do not have any symptomsrelated to cardiovascular system.Results: Our study shows that the prevalence of silent MIamong patients with DM was 20.45%. It was reported inthe present study that the mean fasting and post prandialblood sugar among patients was 162.23±12.18 mg/dl and192.4±21.29 mg/dl respectively.Conclusion: Our study shows that the prevalence of silent MIamong patients with DM was 20.45%. In our study majorityof cases of silent myocardial ischemia were found in patientswith age group of >50 years, patients with duration of diabetesmellitus of 5-10 years
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Background: Silent MI is common among diabetics due to autonomic dysfunction and loss of pain alert mechanism. There are various risk factors associated with silent MI in diabetes which needs screening earlier to prevent unanticipated cardiovascular mortality. The objective of the present investigation was to study the prevalence and clinical factors associated with silent myocardial ischemia as diagnosed by TMT among type 2 diabetics who had no previous history or symptoms of cardio-vascular disease.Methods: A total of 200 type 2 diabetes affected subjects with duration of diabetes for at least 6 months, above 18 years of age, attending to the diabetology OPD, during the time period June 2017 to May 2018 were included in the study. Blood investigations and TMT were done for all the participants and documented in a proforma.Results: Silent MI was documented by using TMT in 36.5% (n=73) of patients with type 2 diabetes mellitus. The factors like age (59.1±16.3 years), duration of diabetes (8.2±2.6 years), obesity (BMI=29.6±4.7 kg/m2), Glycated haemoglobin (9.7±2.8 %), lipid levels and post-prandial blood sugar levels (236±11.8 mg/dl) associated well with silent MI as predicted by TMT. Fasting blood sugar did not show significant association with Silent MI.Conclusions: The prevalence of silent MI was higher among the type 2 diabetic individuals compared to non-diabetics. Age, duration of diabetes, HbA1c levels, BMI, dyslipidemia and post prandial blood glucose levels were associated significantly with incidence of silent MI in patients with type 2 diabetes.
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It has been shown that ischemia preconditioning (IPC) can attenuate the myocardial injury induced by ischemic and reperfusion. But it was rarely used in clinic due to its inoperability. Previous studies indicate that electroacupuncture (EA) pretreatment can mimic myocardial ischemia preconditioning (MIPC) to produce cardioprotective effect. The activated adenosine A 2 b receptor has been proven to be involved in mediating the cardioprotection of IPC. In the studies on acupuncture analgesia, it was reported that adenosine receptor was activated by acupuncture stimulation, and acupuncture pretreatment can affect the acti-vities of intracellular A 2 b receptor. Based on those mentioned above, it is highly likely that the A 2 b receptor may also participate in the cardioprotection produced by acupuncture pretreatment. In this paper, we comprehensively reviewed relevant studies regarding 1) the cardioprotective effect of IPC and its limitations, 2) the similar cardioprotection produced by both acupuncture pre-treatment and IPC, 3) the mechanism underlying myocardial ischemic injury and intracellular calcium regulation, 4) the acti-vation of adenosine receptors and effects of acupuncture, 5) the relationship between adenosine receptors and intracellular calcium ion, and 6) the effect of acupuncture on adenosine receptors, so as to provide a novel assumption that A 2 b receptor may be a key factor in mediating the cardioprotection of acupuncture pretreatment. Our future research will systematically explore the me-chanism of acupuncture pretreatment in protecting ischemic myocardium from myocardial cell adenosine A 2 b receptor and intracellular calcium signal transduction related factors.
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Objective:To investigate the clinical accuracy of cardiac remote monitoring, echocardiography (ECHO) and dynamic electrocardiography (DCG) in the diagnosis for silent myocardial ischemia (SMI) of coronary heart disease (CHD).Methods:63 patients with CHD were enrolled in this retrospective analysis and coronary angiography (CGA) was used as gold standard to analyze and judge the sensitivity, accuracy, specificity, positive predictive value, negative predictive value, Youden index and Kappa value of cardiac remote monitoring technique, ECHO and DCG in the diagnosis for SMI.Results: As the results of gold standard (CGA), 41 cases of 63 patients with CHD were diagnosed as SMI, the diagnose accordance rates of cardiac remote monitoring technique, ECHO and DCG, respectively, were 92.68%, 53.66% and 90.24%. And the sensitivity and specificity of the three methods for SMI, respectively, were 92.68% and 77.27%, 53.66% and 90.24%, and 86.36% and 22.73%. The Youden Indexes of the three methods were 0.700, 0.236 and 0.766, respectively. As above results, the Youden Indexes of cardiac remote monitoring technique and DCG were obviously higher than that of ECHO, and their diagnosis for SMI has excellent accordance with CGA. Conclusion:The technique of cardiac remote monitoring can be used as an effective supplementary means of DCG, and it has great clinical significance in the early diagnosis for SMI.
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Objective:To investigate the clinical accuracy of cardiac remote monitoring, echocardiography (ECHO) and dynamic electrocardiography (DCG) in the diagnosis for silent myocardial ischemia (SMI) of coronary heart disease (CHD).Methods:63 patients with CHD were enrolled in this retrospective analysis and coronary angiography (CGA) was used as gold standard to analyze and judge the sensitivity, accuracy, specificity, positive predictive value, negative predictive value, Youden index and Kappa value of cardiac remote monitoring technique, ECHO and DCG in the diagnosis for SMI.Results: As the results of gold standard (CGA), 41 cases of 63 patients with CHD were diagnosed as SMI, the diagnose accordance rates of cardiac remote monitoring technique, ECHO and DCG, respectively, were 92.68%, 53.66% and 90.24%. And the sensitivity and specificity of the three methods for SMI, respectively, were 92.68% and 77.27%, 53.66% and 90.24%, and 86.36% and 22.73%. The Youden Indexes of the three methods were 0.700, 0.236 and 0.766, respectively. As above results, the Youden Indexes of cardiac remote monitoring technique and DCG were obviously higher than that of ECHO, and their diagnosis for SMI has excellent accordance with CGA. Conclusion:The technique of cardiac remote monitoring can be used as an effective supplementary means of DCG, and it has great clinical significance in the early diagnosis for SMI.
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Objective:To evaluate the clinical value of combined detection of ischemia modified albumin(IMA), N-terminal pro brain natriuretic peptide(NT-proBNP) and dynamicelectrocardiogram(DEG) in the diagnosis of silent myocardial ischemia.Methods: IMA, NT-proBNP and DEG of 114 patients with silent myocardial ischemia who were suspected coronary heart disease were detected, and then these results were compared and analyzed with the results of coronary angiography(CAG).Results: In 114 patients with suspected coronary heart disease, 68 cases(59.65％)were positive as the results of CAG. And there were 60 cases were positive as the results of IMA detection, and the specificity and sensitivity of IMA compared with CAG were 82.61％ and 88.24％, respectively. There were 63 cases were positive as the results of NT-proBNP, and the specificity and sensitivity of NT-proBNP compared with CAG were 80.43％ and 92.64％, respectively. There were 57 cases were positive as the results of DEG, and the specificity and sensitivity of DEG compared with CAG were 86.96％ and 83.82％, respectively. While there were 66 cases were positive as the combined detection of the three methods, and specificity and sensitivity of the combined detection compared with CAG were 95.65％ and 97.06％, respectively. Therefore, the specificity and sensitivity of combined detection were significantly higher than that of alone detection of IMA, NT-proBNP and DEG (F=140.637,F=255.467,P<0.05).Conclusion: The comprehensive analysis for the combined detections of IMA, NT-proBNP and DEG can increase both of the specificity and sensitivity of diagnosis, and it can be used as a important screening method for earlier finding silent myocardial.
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OBJECTIVE:To observe clinical efficacy and safety of Zishen jianpi huoxue decoction combined with Xiaoxintong capsule in the treatment of type 2 diabetes complicating with silent myocardial ischemia (SMI). METHODS:126 patients with type 2 diabetes complicating with SMI were selected and randomly divided into control group(62 case)and observation group(64 cases). Both group were given diet guidance and hypoglycemic drugs as sulfonylureas,biguanides. Control group was given Xiaox-intong capsule 10 mg,tid;observation group was additionally given Zishen jianpi huoxue decoction 400-500 ml,bid. Both groups received treatment for 7 d. Therapeutic efficacy of thoracic obstruction,improvement of coronary artery branch stenosis and times and duration of electrocardiogram ST segment low voltage outlet were observed in 2 groups. ADR was compared between 2 groups. RESULTS:Therapeutic efficacy of thoracic obstruction and improvement of coronary artery branch stenosis in observation group were significantly better than in control group,with statistical significance(P<0.05);the times and duration of electrocardiogram ST segment low voltage outlet in observation group were significantly lesser shorter than in control group,with statistical signifi-cance (P<0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:Zishen jianpi huoxue decoction complicating with Xiaoxintong capsule shows significantly therapeutic efficacy in the treatment of type 2 diabetes complicating with SMI with good safety.
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Objective:To investigate the value of the Holter monitoring in silent myocardial ischemia (SMI).Methods: Sixty-eight patients with silent myocardial ischemia had the Holter monitoring.Results:Sixty-eight cases were detected 263 times of the SMI, Among them 05:00-12:00 highest incidence occurs 156 times total, 52.88% of the total number; second highest incidence of the time period of 18:00-22:00, total occurred 97 times, the total number of of 32.88%; 22:00-05:00 totaling occurred 46 times, the total number of 15.59%. There are a total of 187 predisposing factors array times, 63.34% of the total number. Heart rate greater than 100 bpm, SMI total array occurred 175 times, 59.32% of the total number; heart rate>65 bpm and
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Objective To compare coronary artery abnormality between patients with silent myocardial ischemia (SMI)and pa-tients with symptomatic myocardial ischemia using coronary artery CT angiography.Methods Forty-three patients with SMI and 45 patients with symptomatic myocardial ischemia were collected and underwent coronary CT angiography using 128-slices spiral CT scanner,respectively.Results Stenosis of coronary artery detected in 23 patients with SMI was (23/43,53.49%),and stenosis in 21 patients with symptomatic myocardial ischemia was (21/45,46.67%).The difference of incidence had no statistical significance, but the degree of stenosis and the number of stenosis vessel had statistical significance(P <0.05).The number of atherosclerotic plaque of coronary artery detected in patients with symptomatic myocardial ischemia was significantly more than that in patients with SMI(P <0.05).Conclusion There are no significant difference in the incidence of coronary stenosis between the patients with SMI and patients with symptomatic myocardial ischemia.However,the degree of stenosis and incidence of atherosclerotic plaque are sig-nificant different.
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Background: Silent myocardial ischemia is defined as objective documentation of myocardial ischemia in the absence of angina or anginal equivalents. There are a number of reports of exercise-related sudden deaths and myocardial infarctions in aerobically trained athletes suffering from exercise - induced silent myocardial ischemia. The most appropriate and used method to discover silent myocardial ischemia is the exercise stress testing. Case Reports: In this article the authors describe three emblematic cases of silent myocardial ischemia detected in master marathon runners during systematic prepartecipation screening. These marathon runners were asymptomatic but suffering from a severe coronary artery disease that only thanks to exercise treadmill stress test was detected and properly treated. Conclusions: Silent myocardial ischemia is not such a rare event in athletes, indeed quite the opposite. In fact, even though athletes are asymptomatic this does not exclude the possibility that they are suffering from severe coronary artery disease.
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OBJECTIVE: This study was aimed to evaluate myocardial perfusion in asymptomatic patients with type 1 (DM1) and type 2 diabetes mellitus (DM2) without previous diagnoses of coronary artery disease (CAD) or cerebral infarction. MATERIALS AND METHODS: Fifty-nine consecutive asymptomatic patients (16 DM1, 43 DM2) underwent myocardial perfusion scintigraphy with 99mTc-sestamibi (MPS). They were evaluated for body mass index, metabolic control of DM, type of therapy, systemic arterial hypertension, dyslipidemia, nephropathy, retinopathy, peripheral neuropathy, smoking, and familial history of CAD. RESULTS: MPS was abnormal in 15 patients (25.4%): 12 (20.3%) with perfusion abnormalities, and 3 with isolated left ventricular dysfunction. The strongest predictors for abnormal myocardial perfusion were: age 60 years and above (p = 0.017; odds ratio [OR] = 6.0), peripheral neuropathy (p = 0.028; OR = 6.1), nephropathy (p = 0.031; OR = 5.6), and stress ECG positive for ischemia (p = 0.049; OR = 4.08). CONCLUSION: Silent myocardial ischemia occurs in more than one in five asymptomatic diabetic patients. The strongest predictors of ischemia in this study were: patient age, peripheral neuropathy, nephropathy, retinopathy and a stress ECG positive for ischemia.
OBJETIVO: Este estudo teve por finalidade avaliar a perfusão miocárdica de pacientes com diabetes mellitus tipo 1 (DM1) e tipo 2 (DM2) assintomáticos, sem diagnóstico prévio de doença arterial coronariana (DAC) ou acidente vascular cerebral. MATERIAIS E MÉTODOS: Cinquenta e nove pacientes consecutivos (16 DM1, 43 DM2) foram submetidos a cintilografia de perfusão miocárdica com sestamibi-99mTc (CPM). Foram avaliados quanto ao índice de massa corpórea, controle metabólico do diabetes, dislipidemia, terapia para o diabetes, hipertensão arterial sistêmica, nefropatia, retinopatia, neuropatia periférica, tabagismo e história familiar de DAC. RESULTADOS: CPM foi anormal em 25,4%: 12 (20,3%) com alterações de perfusão e 3 com disfunção ventricular esquerda isolada. Os mais fortes preditores de perfusão miocárdica anormal foram: idade igual ou maior a 60 anos (p = 0,017, odds ratio [OR] = 6,0), neuropatia periférica (p = 0,028, OR = 6,1), nefropatia (p = 0,031, OR = 5,6) e ECG de esforço positivo para isquemia (p = 0,049, OR = 4,08). CONCLUSÃO: A isquemia miocárdica silenciosa ocorre em mais de um em cada cinco diabéticos assintomáticos. Os mais fortes preditores de isquemia foram: idade avançada, neuropatia periférica, nefropatia, retinopatia e ECG de esforço positivo para isquemia.
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Humans , Male , Female , Adult , Middle Aged , Diabetes Mellitus , Ischemia , Perfusion , Radionuclide ImagingABSTRACT
Objetivos: determinar la frecuencia de isquemia miocárdica silente en diabéticos tipo 2 y su relación con el control metabólico. Métodos: se realizó un estudio descriptivo transversal en 79 pacientes asintomáticos con diabetes mellitus tipo 2 sin antecedentes de cardiopatía isquémica, hipertensión arterial o de ser fumador, que acudieron a la Consulta de Endocrinología del Hospital Militar Central Dr Carlos J Finlay, entre febrero de 2009 y febrero de 2011. Se les realizó ecocardiografía con doppler tisular y se determinaron los niveles de glucemia en ayunas, posprandial, hemoglobina glucosilada, colesterol y triglicéridos. Las variables clínicas analizadas en relación con la isquemia miocárdica silente fueron: edad, sexo, tiempo de evolución de la diabetes e índice de masa corporal. Para las variables cualitativas se utilizaron distribuciones de frecuencia con el cálculo del porcentaje y para establecer relación entre variables la prueba de chi cuadrado. Resultados: la edad media del total de pacientes fue de 54 años, de ellos el 69,1 por ciento correspondió al sexo masculino y el 31,9 por ciento al femenino. En el 20,2 por ciento de los pacientes se observaron signos de isquemia miocárdica por doppler tisular, y de ellos, un 75 por ciento tuvo niveles patológicos de colesterol total, con relación estadísticamente significativa (p= 0,01), sujetos que tuvieron 4,4 veces más riesgo relativo de presentar isquemia miocárdica, que los pacientes con colesterol normal. Las cifras de glucemia en ayunas, posprandial y hemoglobina glucosilada fueron significativamente mayor en el grupo con isquemia. Los pacientes con niveles elevados de glucemia en ayunas tuvieron 10,5 veces más riesgo de isquemia miocárdica que los que tenían cifras adecuadas. Igualmente, los casos con cifras elevadas de glucemia posprandial presentaron 12 veces más riesgo de enfermar. Conclusiones: la isquemia miocárdica silente es frecuente en los diabéticos tipo 2 y se relaciona con los niveles patológicos de colesterol y el mal control glucémico(AU)
Objectives: to determine the frequency of silent myocardial infarction in type 2 diabetes patients and its relation with the metabolic control. Methods: a cross-sectional descriptive study of 79 asymptomatic patients suffering type 2 diabetes mellitus and without a history of ischemic cardiopathy, blood hypertension or smoking. These patients were seen at the endocrinology service of Dr Carlos J Finlay from February 2009 to February 2011. They underwent Doppler tissue imaging echocardiography and their levels of glycemia on fasting, pospandrial glycemia, glycated haemoglobin, cholesterol and triglycerides were determined. The analyzed clinical variables lfor the silent myocardial ischemia were age, sex, time of evolution of diabetes and body mass index. Frequency distributions and percentage estimations were used for the qualitative variables whereas the Chi square test served to establish relationships among variables. Results: the average age of the patients was 54 years, 69,1 percent were males and 31,9 percent females. The Doppler tissue imaging echocardiography showed signs of myocardial ischemia in 20 percent of these patients, and 75 percent had pathological levels of total cholesterol with statistically significant relation (p=0.01) and their relative risk of developing myocardial ischemia was 4.4 times higher than the rest of patients with normal cholesterol. The values of glycemia on fasting, pospandrial glycemia and glycated haemoglobin were significantly higher than in the ischemic group. The patients having significantly higher values of glycemia on fasting exhibited a risk of myocardial ischemia that was 10.5 times higher than that of the patients with adequate values for this variable. Likewise, the risk of getting sick was 12 times higher in those cases with high values of pospandrial glycemia. Conclusions: silent myocardial ischemia is frequent in type 2 diabetes mellitus patients and is associated with pathological levels of cholesterol and with poor glycemic control(AU)
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Humans , Male , Female , Middle Aged , Myocardial Ischemia/epidemiology , Diabetes Mellitus, Type 2/complications , Metabolism/physiology , Blood Glucose/analysis , Glycated Hemoglobin/analysis , Epidemiology, Descriptive , Cross-Sectional Studies , Ultrasonography, Doppler/methodsABSTRACT
ObjectiveTo explore the clinical value of application of metoprolol and nifedipine in the treatment of asymptomatic myocardial ischemia for the elderly.Methods56 cases of elderly patients with silent myocardial ischemia were chosen.They were randomly divideded into the metoprolol group of 28 cases and nifedipine group with 28 cases according to the number table.The incidence of complications during treatment in the metoprolol and nifedipine group were analyzed.The seizure frequency and onset time in the two groups of patients were compared before and after treatment.ResultsThe onset time in the two groups,before treatment had no statistically significant difference[the number of attacks:(19.6±3.2) times/week compared with(18.9±2.8) times/week;attack time:(5131±352)s vs (5130 ± 348 ) s,all ( P ＞ 0.05 ).After treatment,there were statistically significant differences for the number of attacks and attack time [the number of attacks:(4.6 ± 2.1 ) times/week compared with ( 7.4 ± 2.1 )times/week,onset tine:(900 ± 140) s vs ( 1440 ± 240 ) s ( all P ＜ 0.05 ).All patients can tolerate the treatment period,there was no cases of myocardial infarction occurs.ConclusionThe metoprolol and nifedipine for the elderly treatment of silent myocardial ischemia was more secure,and metoprolol was more effective than nifedipine.
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BACKGROUND: The present study was designed to develop criteria for screening patients with type 2 diabetes mellitus (T2DM) for asymptomatic coronary artery disease (CAD). METHODS: A total of 213 patients with T2DM without typical angina or chest pain were studied between 2002 and 2007. We also evaluated 53 patients with T2DM who had reported chest discomfort using an exercise treadmill test (ETT). RESULTS: Thirty-one of the 213 asymptomatic patients had positive ETT results. We performed coronary angiography on 23 of the 31 patients with a positive ETT and found that 11 of them had significant coronary stenosis. The main differences between the patients with significant stenosis and those with a negative ETT were age (63.1+/-9.4 vs. 53.7+/-10.1 years, P=0.008) and duration of diabetes (16.0+/-7.5 vs. 5.5+/-5.7 years, P or =60 years) with a long duration of diabetes (> or =10 years). The latter value is similar to that of patients with T2DM who presented with chest discomfort or exertional dyspnea. The PPV of the ETT in symptomatic patients was 76.9%. CONCLUSION: In the interest of cost-effectiveness, screening for asymptomatic CAD could be limited to elderly patients with a duration of diabetes > or =10 years.
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Aged , Humans , Chest Pain , Constriction, Pathologic , Coronary Angiography , Coronary Artery Disease , Coronary Stenosis , Coronary Vessels , Diabetes Mellitus , Diabetes Mellitus, Type 2 , Dyspnea , Exercise Test , Mass Screening , ThoraxABSTRACT
Objectlves To stuaythe relationship between plasma hemoglobin concentration and estimated glomerular filtration rate (eGFR)in elderly patients with ischemic cardiomyopathy (ICM).Methods Clinical data of patients with coronary heart disease who weredischarged from The First Affiliated Hospital,Chongqing Medicai University between 2005 and 2007 were analyzed retrospectively.Echocardiography resuIts.plasma hemoglobin and creatinine concentration were abstracted from the medical records.The study included235 Chinese Han patients with age 60 years and older with angiography confwmed coronary heart disease.silent myocardial ischemia orangina pectoris,of whom 154 had ICM defined as left ventricular end-diastolic diameter(LVDd),male≥56mm,female≥51 mm(63.51±7.70 mm)measured by M-mode echocardiography.The differences in plasma hemoglobin concentration were analyzed retrospec-were no significant changes in plasma hemoglobin concentration and eGFR;however,plasma hernoglobin concentration was related toeGFR significantly positively in elderly patients with ICM due to coronary heart disease.
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AIM:To evaluate the diagnostic value of co-detection of ischemia modified albumin (IMA) and treadmill exercise test (TET) for silent myocardial ischemia (SMI).METHODS:80 patients [55 males and 25 females;mean age (54?8) years] with suspected SMI were selected.All patients were examined with TET and coronary arteriongraphy(CAG) in one week.IMA was detected before TET and two hours after TET.All patients were divided into CHD and NCHD groups combined with the results of CAG.Changes in the concentration of IMA were observed of two groups before and after TET.The diagnostic value of co-detection of ischemia modified albumin and treadmill exercise test was evaluated for SMI.RESULTS:Among the 80 patients,it was diagnosed as CHD 33 cases,NCHD 47 cases.There were significant higher levels of IMA after TET in CHD group (P0.05).IMA levels were significantly higher in the patients of CHD after TET than those patients of NCHD[(13.3?3.5) vs (4.7?1.8) ng/mL,P0.05).The sensitivity value was 81.8% for IMA after TET,specificity was 76.6%,positive predictive value was 71.1%,negative predictive value was 85.7%.The sensitivity was 93.8% with the co-detection of IMA and TET,specificity was 87.5%,positive predictive value was 83.3%,negative predictive value was 95.5%.CONCLUSION:IMA is a useful biochemical marker for the early myocardial ischemia.There is a high sensitivity and negative predictive value for IMA two hours after TET in the diagnosis of SMI.There is much higher diagnostic value with the co-detection of IMA and TET.
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BACKGROUND AND OBJECTIVES: The angiographic profiles and myocardial ischemic variables were compared between patients with and without chest pain during exercise myocardial perfusion scintigraphy in patients with coronary artery stenoses. MATERIALS AND METHODS: Study population were 102 consecutive patients who have significant luminal stenoses (> 50%) on coronary angiography. They underwent symptom-limited treadmill exercise test and myocardial perfusion single photon emission computed tomography (SPECT). Tc-99m methoxylisobutyl isonitrile (MIBI) was injected intravenously at rest and one minute before the termination of exercise. Tomographic images were acquired within 1 hour of tracer injection. Electrocardiographic variables, scintigraphic summed reversibility scores and angiographic profiles were compared between patients with and without chest pain during exercise. RESULTS: Silent ischemia was noted in 52/102 (51%) of the subjects. The summed reversibility score of myocardial SPECT was not significanlty different between patients with (6.0+/-4.2) and without (5.1+/-5.0) chest pain. The extent, vessel distribution and stenosis severity of coronary artery disease were not significantly different between two groups. ST segment depression was more prominent in patients with chest pain (1.51+/-1.49 mm) than without chest pain (0.5+/-1.1 mm) during exercise stress testing. CONCLUSION: The degree of coronary stenoses and scintigraphic myocardial ischemia was not different between patients with and without chest pain during exercise stress testing.
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Humans , Chest Pain , Constriction, Pathologic , Coronary Angiography , Coronary Artery Disease , Coronary Stenosis , Coronary Vessels , Depression , Electrocardiography , Exercise Test , Ischemia , Myocardial Ischemia , Perfusion Imaging , Perfusion , Phenobarbital , Tomography, Emission-Computed, Single-PhotonABSTRACT
Objective The 47 myocardial infarction patients (male 41, female 6, average ages 55 7?9 7 years) with silent myocardial ischemia (type Ⅱ SMI) were chosen The relationship was studied between the history of myocardial infarction (MI)and the degree of coronary arterial stenosis and the residual degree of stenosis after percataneous transluminal coronary angioplasty (PTCA) Methods All patients with MI were performed with exercise testing electrocardiogram to investigate the degree of myocardial ischemia The patients were also studied the degree of coronary arterial stenosis before and after PTCA Results The results showed before PTCA, the degree of the patients′ coronary arterial stenosis with a period of no more than three months of MI was higher than that of those patients′ with a period of over three months( P
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Objetivo Avaliar relação entre o aumento da idade e a incidência e a duração de episódios de isquemia miocárdica silenciosa (IMS). Métodos Dentre 1.300 portadores de coronariopatia analisados por Holter, foram selecionados 330 com comprovação segura de lesão em artéria coronária. Eles foram divididos em 4 faixas etárias de idade:< 50 anos; 50 a 59; 60 a 69 e ³ 70 anos. O Holter foi feito em 24 ou 48 horas, sem interrupção da medicação anti-anginosa, em aparelho CardioData. A análise estatística foi elaborada com 2 modelos alternativos: o modelo de regressão logística e o modelo de Poisson. Resultados A isquemia miocárdica (IM) foi registrada em 72 (21,8%) pacientes, 55 (76%) pacientes só apresentaram IMS, 6 (9%) só manifestaram isquemia miocárdica anginosa (IMA) e 11 (15%) pacientes tiveram IMS e IMA. Houve aumento progressivo do número e da duração dos episódios de IM com o aumento da idade. No grupo com < 50 anos a IM ocorreu em 12,12% incidência que aumentou para 19,75%, 22,25% e 32,48% respectivamente nas 3 faixas etárias subseqüentes. A duração em minutos dos episódios de IM por paciente nos com idade < 50 era de 37, e de 36,5, 60,8 e 85,1 nas 3 faixas etárias subseqüentes. A análise estatística pelos 2 métodos mostrou que o aumento de número e da duração dos episódios de IM era significativo...
Purpose To evaluate whether the number and duration of the episodes of silent myocardial ischemia increase with aging of patients. Methods A Holter monitoring, with CardioData equipment, was made in 1.300 patients and 330 with proven significant coronary obstructions were selected for this study. The antianginal medication was maintained during the 24 or 48 hours of Holter recording. The patients were arbitrarily divided into four groups according to age < 50 years, 50 to 59 years, 60 to 69 years and ³ 70 years old. The statistical analysis was made with two models, the model of logistic regression and the Poisson model. Results Myocardia ischemia was delected in 72 patients (21.8%), 55 (76%) had only silent episodes, 6 (9%) had only anginal ischemia and 11 patients (155) had both silent and anginal ischemia. There was a progressive increase in the number and duration of the episodes of myocardial ischemia with aging. The proportion of patients with episodes of myocardial ischemia in the 4 age groups was 12.12%, 19,75%, 22.25% and 31.48% and the duration of the episodes of ischemia per patient 37, 37.5, 50.8 and 85.1 minutes, respectively.