Clinical significance of exercise-induced silent myocardial ischemia in patients with coronary artery disease

Abstract

Exercise-induced silent myocardial ischemia is a frequent feature in patients with coronary artery disease. The purpose of this study was to compare the clinical and angiographic characteristics of 269 patients who complained of chest pain during an exercise test (group I) with those of 204 who developed exercise-induced silent myocardial ischemia (group II). Group I patients more frequently had anginal symptoms of class III and IV of the Canadian Cardiovascular Society than did group II patients, who had milder symptoms (p less than 0.001). The only angiographic difference observed between the two groups was a slightly but significantly higher left ventricular end-diastolic pressure in group II patients (p less than 0.05), who also showed a longer exercise duration (p less than 0.01) with a higher heart rate-systolic pressure product (p less than 0.01) and more pronounced ST segment depression at peak exercise (p less than 0.001). Moreover, ventricular ectopic beats during exercise were more frequently observed in group II patients (p less than 0.05). Coronary bypass surgery was performed in 45% of patients of group I and in 24% of patients of group II (p less than 0.05). Survival curves of medically treated patients did not show any statistically significant difference between the two groups. Thus, although patients with a defective anginal warning system may have more pronounced signs of myocardial ischemia and a greater incidence of ventricular arrhythmias during exercise, their long-term prognosis is not different from that of patients who are stopped by angina from the activity that is inducing myocardial ischemia.

Assessment of Asymptomatic Coronary Artery Disease in Apparently Uncomplicated Type 2 Diabetic Patients

“…1. All 1,323 patients underwent exercise stress testing (19). Subjects were requested to discontinue any antihypertensive drug with anti-ischemic properties, including ␤-blockers and calcium channel blockers.…”

“…In patients with highly positive results of ECG and those with positive results of scintigraphy, diagnostic coronary angiography was recommended. Coronary angiography was performed as previously reported (19). An atherosclerotic lesion was considered significant when stenosis Ն50% of the lumen in at least one major vessel was documented.…”

Silent coronary artery disease in diabetes - a feature of autonomic neuropathy or accelerated atherosclerosis?

“…One attractive way to evaluate the role of a defective anginal perceptual threshold as the cause of silent Ex-ECG = exercise electrocardiography, Th-201 = exercise thallium scintigraphy, Holter = ambulatory electrocardiogram monitoring, NA = not available [36] Ex-ECG 100 % 9 % (22 of 242) 9 % (54 of 600) Falcone et al [37] Ex-ECG 100 % 4 % (10 of 269) 6 % (12 of 204) Chipkin et al [38] Ex-ECG 48 % 14 % (14 of 101) 11 % (12 of 110) DeBelder et al [39] Ex-ECG 88 % 16 % (11 of 67) 8 % (3 of 37) Ouyang et al [40] Ex-ECG 100 % 24 % (9 of 38) 0 % (0 of 22) a Kurata et al [41] Th-201 66 % 24 % (26 of 108) 34 % (of 65) Hecht et al [42] Th-201 100 % 13 % (11 of 84) 32 % (9 of 28) a Gasperetti et al [43] Th Ex-ECG = exercise electrocardiography, Th-201 = thallium scintigraphy, NA = not available a p < 0.05 and b p < 0.001 for the comparison between the groups myocardial ischaemia is to measure the time interval from the emergence of ST segment changes to the onset of chest pain during exercise testing. Exercise electrocardiography done on 32 diabetic and 36 nondiabetic patients with angina pectoris showed that the diabetic patients experienced chest pain later after the onset of ST depression than the non-diabetic ones [48].…”

Association Between Silent Coronary Artery Disease, Diabetes, and Autonomic Neuropathy: Fact or Fallacy?

“…There are several studies that have compared the clinical characteristics of patients with angiographically documented coronary artery disease who have either silent or painful myocardial ischemia (Table 1; [22][23][24][25][26][27][28][29]. Although potential bias in the selection of patients for noninvasive testing cannot be excluded, these studies have not revealed any significant preponderance of diabetic subjects in the group with silent myocardial ischemia.…”