title: Prevalence of silent myocardial ischaemia during exercise stress testing. Its relation to effort tolerance and myocardial perfusion abnormalities.
abstract: The number of underperfused myocardial segments, the extent of coronary artery disease and the severity of impairment of coronary flow reserve were compared in 147 consecutive patients exhibiting painful or painless ischaemic ST segment depression on exercise testing. Of 147 patients, only 61 (41%) experienced angina (group 1) whilst 86 (59%) did not (group 2). In the two groups coronary disease was comparable for both extent and distribution, and neither the location of transient perfusion defects nor their relation to areas of old myocardial necrosis appeared to influence the presence or absence of chest pain. However, exercise duration, exercise time and rate-pressure product at the beginning of ischaemia were lower in group 1. Furthermore, a greater proportion of asymptomatic patients had only one ischaemic segment on 99mTc-MIBI perfusion scintigraphy. We conclude that: (1) in patients with effort angina and coronary disease, the incidence of electrocardiographic silent ischaemic events induced by exercise is similar to that observed in studies based on continuous ECG monitoring. (2) Exertional angina is more frequently associated with greater ischaemic areas and with more severe degrees of impairment of residual coronary flow reserve. (3) The presence of an old myocardial infarction does not appear to influence the incidence of ischaemic cardiac pain.
authors.affiliation: Division of Cardiology, Istituto Scientifico Ospedale San Raffaele, Milano, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Fragasso
authors.forename: M G
authors.initials: MG
authors.lastname: Sciammarella
authors.forename: E E
authors.initials: EE
authors.lastname: Rossetti
authors.forename: R G
authors.initials: RG
authors.lastname: Xuereb
authors.forename: M
authors.initials: M
authors.lastname: Xuereb
authors.forename: F
authors.initials: F
authors.lastname: Bonetti
authors.forename: O M
authors.initials: OM
authors.lastname: Carandente
authors.forename: A
authors.initials: A
authors.lastname: Margonato
authors.forename: S L
authors.initials: SL
authors.lastname: Chierchia
mesh_terms: D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003287:Contrast Media; D003326:Coronary Circulation / Q000502:physiology*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology*; D009570:Nitriles; D015609:Organotechnetium Compounds; D012039:Regional Blood Flow / Q000502:physiology; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D003287:Contrast Media; D009570:Nitriles; D015609:Organotechnetium Compounds; D017256:Technetium Tc 99m Sestamibi