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Z. Pagava,
N.Chagiashvili, G. Mamaladze, I.Maisuradze, M. Tsiskaridze, L. Donadze,
I. Mdivani, Ts. Qristesiashvili, D.Bachtadze, S. Tsikarishvili
Institute of Cardiology, Tbilisi, Rehabilitation Center |
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Key words:
myocardial ischemia, Q-wave infarction, silent ischemia,
exercise-induced ischemia.
The question
addressed by this study was the evaluation of the clinical and
prognostic significance of different type of exercise-induced ischemia
in patients with previous Q-wave myocardial infarction.
120 consecutive stable patients (mean 56,2 ± 8.6 years ) with previous
MI who underwent a Bruce treadmill test were enrolled in our study. The
patients were retrospectively classified into 4 groups according to
exercise test results: 1-painless ischemia, 26 patients, 2-painfull
ischemia, 14 patients, 3-negative ET, 12 patients, 4-nondiagnostic ET 68
patients. Patients with painless ischemia had less functional impairment
and less exercise ischemia than the symptomatic patients (longer
exercise duration p < 0,05, higher double product p< 0,05, higher
ischemic threshold p < 0,01 , and shorter time to ST normalization p <
0,001. Annual mortality rate for patients with painless exercise ST
segment deviation was 2,5 - times less than for patients with painful
ischemia (p< 0,05) . Patients with silent ischemia demonstrated similar
higher 5 year survival rate. (p < 0,5)
Stable patients with previous Q-wave MI represent a very low –risk
population. In this subset, painless exercise–induced ischemia signifies
less severe ischemia than the symptomatic one and has prognostic power.
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Literature:
1. Gibbon et all , Exercise testing guidelines , JACC
Vol. 30 , No1, July 1997;260-315
2. Fletcher G.F.,Schlant R.C., The exercise test, Hurst’s the heart ,8th
edition , 423-440
3. Гасилин В.С., Сидоренко Б.А.,Стенокардия -2-е издание-М., 1987
4. Липоветский Б.М.Функциональная оценка коронарного кровотока у
человека –Л., 1985
5. Лякишев А.А.и др.,Использование функциональных методов исследования в
диагностике , оценке тяжести течения и прогнозе ишемической болезни
сердца , Мет. рекомендации-М .,1988
3. WeinerDA, Ryan TJ, McCabe CH, et al . Significance of silent
myocardial ischemia during exercise testing in patients with coronary
artery disease. Am J Cardiol 1987;59:725-729
4. Falcone C, De Servi s, Poma E, et al. Clinical significance of
exercise-induced silent myocardial ischemia in patients with coronary
artery disease. J Am Coll Cardiol 1987;9:255-259
5. assey ME, Walters GL, Hendrix GH, Carabello BA, Usher BW, Spann JF
Jr. Incidence of acute myocardial infarction in patients with
exercise-induced silent myocardial ischemia. Am J Cardiol 1987
;59:497-500
6. Callaham PR, Froelicher VF, Klein J, Risch M, Dubach P, Friis R .
Exercise-induced silent ischemia : age, diabetes mellitus, previous
myocardial infarction and prognosis. J Am Coll Cardiol 1989
;14:1175-1180
7. Nicod P, Gilpin E, Dittrich H, et al. Short –and long-term clinical
outcome after Q wave and non-q WAVE Myocardial infarction in a large
patients population. circulation 1989;79:528-536 |