Vol.7, No 1, 2000 pp. 56 -61
UC 612.17
PREVALENCE, CHARACTERISTICS AND THREE YEARS PROGNOSTIC SIGNIFI-CANCE OF SILENT MYOCARDIAL ISCHEMIA
DURING EARLY EXERCISE TESTING IN PATIENTS
AFTER THE FIRST MYOCARDIAL INFARCTION
Stevan N. Ilić, Marina Ž. Deljanin Ilić, Branko K. Lović, Aleksandar Nikolić, Vojislava Mitić, Ivan Tasić, Dragan Djordjević, Dragan Mijalković, Ljubiša Nikolić
Institute of Cardiology, Niška Banja, University of Niš, Yugoslavia
e-mail: stevanil@junis.ni.ac.yu
Summary. The aim of this study was to evaluate the frequency, some characteristics and prognostic significance of silent myocardial ischemia  during early exercise testing in patients  after myocardial infarction. In the group of 210 patients within three months after myocardial infarction submaximal or symptom-limited exercise test were performed. Out of 210 patients 88 (42%) had is-chemic response on exercise electrocardiogram and 2D exercise echocardiogram. Out of 88 patients with ischemic response on exercise electrocardiogram and echocardiogram 54 (61%) had anginal pain or it's equiva-lents (symptomatic myocardial ischemia) and 34 (39%) had not ischemic symptoms (si-lent myocardial ischemia). Diabetes  mellitus and arterial hypertension was more frequent in patients with silent than in patients with symptomatic myocardial ischemia. Level of exercise test and heart rate at the onset of both types of myocardial ischemia were not differ significantly. Duration of exercise testing was significantly bigger in patients with silent myocardial ischemia. The average magnitude and dura-tion of ST-segment depression in both groups of pts with myocardial ischemia were similar. Before exercise test wall motion score index (WMSI) was similar in both groups of patients. After exercise stress echocardiography WMSI significantly rised in both groups, but more in patients with symptomatic  ischemia, and after exercise test WMSI was significantly bigger in patients with symptomatic ischemia. During three years follow-up there were no significant differences in mortality, reinfarction and coronary artery by-pass surgery rate between patients with symptomatic and silent myocardial ischemia.
This study showed that: silent myocardial ischemia, during early exercise testing was frequent finding in patients after myocardial infarction, especialy in those with diabetes mellitus and arterial hypertension; there were not significant differences in characteristics between silent and symptomatic myocardial ischemia on exercise electrocardiogram; and  three years prog-nostic significance of both types of myocardial ischemia was similar.
Key words: Silent myocardial ischemia, myocardial infarction, exercise testing, stress echocardiographic test
UČESTALOST, KARAKTERISTIKE I TROGODIŠNJI PROGNOSTIČKI ZNAČAJ ASIMPTOMATSKE MIOKARDNE ISHEMIJE REGISTROVANE U TESTU FIZIČKIM OPTEREĆENJEM U BOLESNIKA S PREŽIVELIM INFARKTOM MIOKARDA

Kratak sadržaj: Cilj ove studije je odredjivanje učestalosti, nekih karakteristika i prognostičkog značaja asimptomatske miokardne ishemije koja je registrovana tokom ranog testa fizičkim opterećenjem u bolesnika s preživelim infarktom miokarda. Grupi od 210 bolesnika, unutar tri meseca od akutnog infrakta miokarda uradjen je submaksimalni ili simptomom limitirani test fizičkim opterećenjem. Od 210 bolesnika u 88 (42%) registrovane su ishemijske promene na elektrokardiogramu i 2D ehokardiogramu u opterećenju. Simptomatska miokardna ishemija (anginozni bol ili ekvivalenti anginoznog bola) nadjena je u 54 od 88 bolensika (61%), dok u 34 (39%) bolesnika miokardna ishemija nije bila praćena ishemijskim simpotomima (asimptomatska miokardna ishemija). Dijabetes i artarijska hipertenzija bili su čeći u bolesnika sa asimptomatskom miokardnom ishemijom. Nivo opterećenja, srčana frekvencija pri pojavi miokardne ishemije, kao i veličina ST segment depresije bili su slični u obe grupe bolesnika sa miokardnom ishemijom. Trajanje opterećenja bilo je značajno duže u bolesnika sa asimptomatskom miokardnom ishemijom. Abnormalnosti pokreta zidova leve komore tokom opterećenja (WMSI) bili su izraženiji u bolesnika sa simptomatskom miokardnom ishemijom. Tokom trogodišnjeg praćenja nije postojala značajna razlika u pojavi velikih srčanih dogadjaja (kardijalnog mortaliteta i ponovnog infrakta miokarda) u bolesnika sa simptomatskom i asimptomatskom miokardnom ishemijom. U bolesnika sa simptomatskom miokardnom ishemijom bila je češća pojava angine pektoris a potreba za hirurškom revaskularizacijom bila je slična, kada se analiziraju podgrupe bolesnika kod kojih se tokom praćenja javila angina pektoris.
Naša studija je pokazala da asimptomatska miokardna ishemija postoji u više od trećine bolesnika sa preživelim infarktom miokarda i miokardnom ishemijom u testu fizičkim opterećenjem, da je češća u bolesnika sa arterijskom hipertenzijom i dijabetesom, da bolesnici sa asimptomatskom miokardnom ishemijom imaju duže trajanje opterećenja i manje abnormalnosti pokreta zidova leve komore u opterećenju i da je trogodišnje prognoza bolesnika sa simptomatskom i asimptomatskom miokardnom ishemijom slična.
Ključne reči:  Asimptomatska miokardna ishemija, angina pektoris, infarkt miokarda, test fizičkim opterećenjem, ehokardiografski stres test