title: [Multicenter study on exercise-induced silent myocardial ischemia: clinical, anamnestic and ergometric parameters in 4389 patients with proven ischemic cardiopathy].
abstract: OBJECTIVE
  In order to evaluate the incidence and clinical significance of myocardial ischemia during exercise testing (ExT) in patients (pts) with proven ischemic heart disease (Stable Effort Angina = SEA, Myocardial Infarction = MI, PTCA or CABG) 73 ergometric laboratories participated in a multicenter prospective study (SMISS) coordinated by the Italian Working Group on Cardiac Rehabilitation. Here we report the clinical and ergometric parameters.
  
  
  METHODS
  Over a period of six months 4,389 consecutive pts were enrolled in the study after performing a maximal limited ExT (25 watts x 3') after drug withdrawal. All pts are followed at 6 and 12 months, at which time electrocardiogram, physical examination and clinical history were reassessed. A preliminary quality control of ECGraphic signal of ischemia was performed. Between the core center and the ergometric laboratories there was an 88% agreement (positive/negative ECG). 617 (14%) pts with angina (Group A), 2621 (59.7%) MI pts (Group B), 313 (7.2%) PTCA pts (Group C1), 838 (19.1%) patients with previous coronary bypass (Group C2) were studied.
  
  
  RESULTS
  Interruption criteria were: maximal heart rate (11.7%), fatigue (66.6%), angina (10.9%), dispnea (2.3%), ST depression (13.9%), complex VPBs (2.2%), abnormal blood pressure (3.3%). In all pts the maximal work load was 100.3 +/- 31 W (lower in SEA pts). HR was 141 +/- 20/min at maximal work load (lower in SEA pts). The incidence of complex VPBs was 7.9% (higher in Mi and CABG pts). The results of ExT were: normal in 62% of all pts (21% in SEA pts), angina alone in 3.3% (7.6% in SEA pts and 1.8% in MI pts), symptomatic ischemia in 12.7% (40% in SEA pts, 9.3% in MI pts and 5.7% in CABG pts), silent ischemia in 22% (31.8% in SEA pts, 21.6 in MI pts and 16.6% in CABG pts). All differences were significant (p < 0.01).
  
  
  CONCLUSIONS
  In a low risk group of coronary patients the incidence of myocardial ischemia during ExT was 38%. Ischemia was silent in 58% of the patients.
authors.affiliation: Divisione di Cardiologia, Fondazione Clinica del Lavoro, IRCCS, Veruno NO.
authors.forename: G
authors.initials: G
authors.lastname: Ignone
authors.forename: M
authors.initials: M
authors.lastname: Vona
authors.forename: S
authors.initials: S
authors.lastname: Scardi
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D000787:Angina Pectoris / Q000175:diagnosis; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000175:diagnosis*; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis; D011446:Prospective Studies
vernacular_title: Studio multicentrico sull'ischemia silente da sforzo-SMISS: parametri clinico-anamnestici ed ergometrici in 4389 pazienti con cardiopatia ischemica nota.