Silent versus symptomatic myocardial ischemia during exercise testing: a comparison with coronary angiographic findings.
Two-hundred-and-eighty individuals with anginal complaints, without prior myocardial infarction and with a positive exercise stress test were divided into a group (n = 67) with exercise-induced silent myocardial ischemia and another group (n = 213) with exercise-induced angina pectoris. Both underwent coronary angiography and were compared with each other with respect to various exercise and angiographic parameters. Patients with exercise-induced silent ischemia attained a longer mean exercise duration (P less than 0.001), a higher peak exercise heart rate (P less than 0.0001) and a higher peak exercise rate pressure product (P less than 0.001) than patients with exercise-induced angina pectoris. In the latter group, more patients showed exercise-induced ST-segment depression greater than 2 mm (P less than 0.05). The group of patients with silent ischemia encompassed more individuals with normal coronary arteries (P less than 0.0001). More patients with exercise-induced angina pectoris had three-vessel disease (P less than 0.0001). The exclusion of patients with normal coronary arteries (23% in those with silent ischemia group and 6% in those with exercise-induced angina had no influence on the level of significance for peak heart rate, mean exercise duration and exercise duration greater than 10 min. Thus, in this population, exercise-induced silent myocardial ischemia is associated with better exercise performance and less extensive coronary arterial pathology than in exercise-induced angina pectoris.
Visser
F C
FC
Department of Cardiology, Free University Hospital, Amsterdam, The Netherlands.
van Leeuwen
F T
FT
Cernohorsky
B
B
van Eenige
M J
MJ
Roos
J P
JP
D000328:Adult; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000503:physiopathology; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis*; D004562:Electrocardiography; D005080:Exercise Test; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D013312:Stress, Physiological / Q000503:physiopathology