Symptomatic and silent myocardial ischemia during exercise testing in coronary artery disease

Ezra A Amsterdam, Robert Martschinske, Lawrence J. Laslett, John C Rutledge, Zakauddin Vera

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

During exercise by patients with coronary artery disease (CAD), electrocardiographic evidence of myocardial ischemia may precede the onset of angina or may be unassociated with angina, even at peak levels of stress. However, neither the precise incidence of silent versus symptomatic ischemic episodes nor their interrelation in this setting has been clearly defined. The prevalence of silent and symptomatic myocardial ischemia during treadmill exercise testing was determined in 92 patients with angiographically documented CAD. The study group comprised 77 men (84%) and 15 women (16%) of mean age 57 years (range 32 to 79). Exercise testing resulted in ischemic ST-segment depression (≥1 mm for ≥80 ms) only or in association with delayed (≥1 minute) angina in 39 patients (42%); angina only or in association with delayed ST-segment depression occurred in 42 patients (46%); and simultaneous occurrence of angina and ST-segment depression was noted in 11 patients (12%). Analysis of clinical, exercise and angiographic factors (age, sex, history of myocardial infarction, heart rate, maximal ST-segment depression, extent of CAD and left ventricular ejection fraction) revealed no significant correlation with the frequency of symptomatic and silent myocardial ischemia during exercise. Asymptomatic myocardial ischemia occurred commonly during exercise in patients with CAD, but there were no differences in the characteristics of patients with symptomatic and asymptomatic episodes.

Original languageEnglish (US)
JournalThe American journal of cardiology
Volume58
Issue number4
DOIs
StatePublished - Aug 15 1986

Fingerprint

Myocardial Ischemia
Coronary Artery Disease
Exercise
Sex Factors
Age Factors
Stroke Volume
Heart Rate
Myocardial Infarction
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Symptomatic and silent myocardial ischemia during exercise testing in coronary artery disease. / Amsterdam, Ezra A; Martschinske, Robert; Laslett, Lawrence J.; Rutledge, John C; Vera, Zakauddin.

In: The American journal of cardiology, Vol. 58, No. 4, 15.08.1986.

Research output: Contribution to journalArticle

@article{3b224664db184acbaa97dda43319d106,
title = "Symptomatic and silent myocardial ischemia during exercise testing in coronary artery disease",
abstract = "During exercise by patients with coronary artery disease (CAD), electrocardiographic evidence of myocardial ischemia may precede the onset of angina or may be unassociated with angina, even at peak levels of stress. However, neither the precise incidence of silent versus symptomatic ischemic episodes nor their interrelation in this setting has been clearly defined. The prevalence of silent and symptomatic myocardial ischemia during treadmill exercise testing was determined in 92 patients with angiographically documented CAD. The study group comprised 77 men (84{\%}) and 15 women (16{\%}) of mean age 57 years (range 32 to 79). Exercise testing resulted in ischemic ST-segment depression (≥1 mm for ≥80 ms) only or in association with delayed (≥1 minute) angina in 39 patients (42{\%}); angina only or in association with delayed ST-segment depression occurred in 42 patients (46{\%}); and simultaneous occurrence of angina and ST-segment depression was noted in 11 patients (12{\%}). Analysis of clinical, exercise and angiographic factors (age, sex, history of myocardial infarction, heart rate, maximal ST-segment depression, extent of CAD and left ventricular ejection fraction) revealed no significant correlation with the frequency of symptomatic and silent myocardial ischemia during exercise. Asymptomatic myocardial ischemia occurred commonly during exercise in patients with CAD, but there were no differences in the characteristics of patients with symptomatic and asymptomatic episodes.",
author = "Amsterdam, {Ezra A} and Robert Martschinske and Laslett, {Lawrence J.} and Rutledge, {John C} and Zakauddin Vera",
year = "1986",
month = "8",
day = "15",
doi = "10.1016/0002-9149(86)90409-1",
language = "English (US)",
volume = "58",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - Symptomatic and silent myocardial ischemia during exercise testing in coronary artery disease

AU - Amsterdam, Ezra A

AU - Martschinske, Robert

AU - Laslett, Lawrence J.

AU - Rutledge, John C

AU - Vera, Zakauddin

PY - 1986/8/15

Y1 - 1986/8/15

N2 - During exercise by patients with coronary artery disease (CAD), electrocardiographic evidence of myocardial ischemia may precede the onset of angina or may be unassociated with angina, even at peak levels of stress. However, neither the precise incidence of silent versus symptomatic ischemic episodes nor their interrelation in this setting has been clearly defined. The prevalence of silent and symptomatic myocardial ischemia during treadmill exercise testing was determined in 92 patients with angiographically documented CAD. The study group comprised 77 men (84%) and 15 women (16%) of mean age 57 years (range 32 to 79). Exercise testing resulted in ischemic ST-segment depression (≥1 mm for ≥80 ms) only or in association with delayed (≥1 minute) angina in 39 patients (42%); angina only or in association with delayed ST-segment depression occurred in 42 patients (46%); and simultaneous occurrence of angina and ST-segment depression was noted in 11 patients (12%). Analysis of clinical, exercise and angiographic factors (age, sex, history of myocardial infarction, heart rate, maximal ST-segment depression, extent of CAD and left ventricular ejection fraction) revealed no significant correlation with the frequency of symptomatic and silent myocardial ischemia during exercise. Asymptomatic myocardial ischemia occurred commonly during exercise in patients with CAD, but there were no differences in the characteristics of patients with symptomatic and asymptomatic episodes.

AB - During exercise by patients with coronary artery disease (CAD), electrocardiographic evidence of myocardial ischemia may precede the onset of angina or may be unassociated with angina, even at peak levels of stress. However, neither the precise incidence of silent versus symptomatic ischemic episodes nor their interrelation in this setting has been clearly defined. The prevalence of silent and symptomatic myocardial ischemia during treadmill exercise testing was determined in 92 patients with angiographically documented CAD. The study group comprised 77 men (84%) and 15 women (16%) of mean age 57 years (range 32 to 79). Exercise testing resulted in ischemic ST-segment depression (≥1 mm for ≥80 ms) only or in association with delayed (≥1 minute) angina in 39 patients (42%); angina only or in association with delayed ST-segment depression occurred in 42 patients (46%); and simultaneous occurrence of angina and ST-segment depression was noted in 11 patients (12%). Analysis of clinical, exercise and angiographic factors (age, sex, history of myocardial infarction, heart rate, maximal ST-segment depression, extent of CAD and left ventricular ejection fraction) revealed no significant correlation with the frequency of symptomatic and silent myocardial ischemia during exercise. Asymptomatic myocardial ischemia occurred commonly during exercise in patients with CAD, but there were no differences in the characteristics of patients with symptomatic and asymptomatic episodes.

UR - http://www.scopus.com/inward/record.url?scp=0022553029&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0022553029&partnerID=8YFLogxK

U2 - 10.1016/0002-9149(86)90409-1

DO - 10.1016/0002-9149(86)90409-1

M3 - Article

C2 - 3751902

AN - SCOPUS:0022553029

VL - 58

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 4

ER -