Prevalence and prognostic significance of exercise-induced silent myocardial ischemia in apparently healthy subjects (original) (raw)
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Journal of the American College of Cardiology, 1988
The reldion of siteat ischemia in patients with stable angina to known predictors of severity of coronary dii on exercise stress testing and coronaq angiography is poorly de&d. TLL issue was therefore examined with use ef HOW ekctmmdiipldc (ECG) recordi, treadmill exe&se t&3 Plrd ongiographic i&xes ill 102 patients (not takiq antian&al therapy) and the results were compared with Hdter and tre&niU findings in 42 vohmteers. A total d 159 is&e& episodes (90% silent) were identikd during 2,503 h on Hotter recordiig in 97 patients (mean duration per episode 22.7 + 147 min; range 1 to 234). H&r recordings had a 92% specificity and an 80% positive predictive value, hut a sensitivity of only 37% and a ~@ve predictive value of 27% for coronary dii. sixty-three patients (Group I) had no i&e& on Hdter recordhtg, 22 (Group 11) bad a cumulative duration of 1 to 60 lain&l h and in 12 (Group 111) ischensia exceeded 60 r&O4 h. There WPJ no sigNkant correlation between There is now compelling evidence that spontaneous episodes of transient myocardial ischemia in the absence of symptoms occur in unstable as well as stable coronary syndromes (I-6). Although such asymptomatic episodes. termed "silent cumutative is&e& duratien 011 Helter recur&g exercise duration OT time to ST segmeut depressien 011 treadmill exercise. In genera& th pitter tk msm coronary wssels invelved coronary artery stenosis i!xhemiaaItdtkEolQer on Ho&et recnrdiqg. irmpef3ive of the severity of carenary dii, in about 25% of Hotter w ia each angiographii category there were no ischemic epkodes. The 12 patients in Group III (isehemia duration Ml mid24 h) had a If&d greater probabitity of having three vesselorieft-dfscoseaada4 er probability of h&g a frigllcr proxhd ry slenosis index (p C 8.&33 zr#l p C 0.@4, respectively). Thus, evidcnre of prdoqgd ischenda oa Mter ECG recording increases the liktlikood that a pa&eat has mnttivessei coronary diiase hut its absence is Or We predictive value. (J Am Cd Ctwdkd 1988;I2:M9-76~
The American Journal of Cardiology, 1984
This retrospective study examines the prognostic significance of exercise-induced ventricular arrhythmia in patients with stable coronary artery disease (CAD) who were included in the mulUcenter patient registry of the Coronary Artery Surgery Study. The population is composed of 1,486 patients selected from 1975 to 1979 and followed an average of 4.3 years. All underwent a standard Bruce exercise test and had CAD by cardiac catheterization at entry. Patients were classified into group I or II depending on whether they had minimal or significant CAD. (Significant CAD was defined as 70% or greater diameter reduction in any major coronary artery or 50 % or greater narrowing in the left main artery.) They were further subclassified into groups A or B depending on whether or not they had exercise-induced ventricular arrhythmia, Groups IA (16 patients) and IB (229 patients) had similar clinical and angiographic characteristics except for the average ejection fraction (EF), which was 50 % for group IA and 64% for group IB (p <0.05). Group IIA (130 patients) had a higher prevalence of previous myocardial infarction, a lower mean EF and a higher proportion of patients with at least 2 coronary arteries significantly narrowed than group liB (1,111 patients). The 5-year event-free survival was not influenced by the presence of exercise-induced ventricular arrhythmla; it was 76 and 88 % in groups IA and IB, respectively (difference not significant), and 71 and 76 % in groups IIA and liB, respectively (difference not significant).
Exercise-Induced Ventricular Arrhythmias and Cardiovascular Death
Annals of Noninvasive Electrocardiology, 2005
Background: Exercise-induced ventricular arrhythmias (EIVA) are frequently observed during exercise testing. However, the clinical guidelines do not specify their significance and so we examined this issue in our population. Methods: A retrospective analysis of prospectively collected data was performed on 5754 consecutive male veterans referred for exercise testing at two university-affiliated Veterans Affairs Medical Centers. Exercise test responses were recorded and cardiovascular mortality was assessed after a mean follow-up of 6 ± 4 years. EIVA were defined as frequent premature ventricular complexes (PVCs) constituting more than 10% of all ventricular depolarizations during any 30-second ECG recording, or a run of three or more consecutive PVCs during the exercise test or recovery. Results: EIVA occurred in 426 patients (7.4%). There were 550 (10.6%) cardiovascular deaths during follow-up. Seventy two (17%) patients with EIVA died of cardiovascular causes, whereas 478 (9.0%) of patients without EIVA died of cardiovascular causes (P < 0.001). Patients with EIVA had a higher prevalence of cardiovascular disease, resting PVCs, resting ST depression, and ischemia during exercise than patients without EIVA. In a Cox hazards model adjusted for age, cardiovascular disease, exercise-induced ischemia, ECG abnormalities, exercise capacity and risk factors, EIVA was significantly associated with time to cardiovascular death. The combination of both resting PVCs and EIVA was associated with the highest hazard ratio. Conclusions: EIVA are independent predictors of cardiovascular mortality after adjusting for other clinical and exercise test variables; combination with resting PVCs carries the highest risk.
Exercise and Acute Cardiovascular Events
Circulation, 2007
Habitual physical activity reduces coronary heart disease events, but vigorous activity can also acutely and transiently increase the risk of sudden cardiac death and acute myocardial infarction in susceptible persons. This scientific statement discusses the potential cardiovascular complications of exercise, their pathological substrate, and their incidence and suggests strategies to reduce these complications. Exercise-associated acute cardiac events generally occur in individuals with structural cardiac disease. Hereditary or congenital cardiovascular abnormalities are predominantly responsible for cardiac events among young individuals, whereas atherosclerotic disease is primarily responsible for these events in adults. The absolute rate of exercise-related sudden cardiac death varies with the prevalence of disease in the study population. The incidence of both acute myocardial infarction and sudden death is greatest in the habitually least physically active individuals. No stra...