title: Diagnostic and prognostic value of ambulatory ECG (Holter) monitoring in patients with coronary heart disease: a review.
abstract: Silent ischemia, the most common expression of atherosclerotic heart disease, affects approximately 30-50% of patients during their activities of daily living. The present review provides a comprehensive and practical summary of current knowledge on perioperative myocardial ischemia through MEDLINE searches up to June 2005, using keywords including "silent ischemia," "transient ischemia," and "Holter monitoring." Holter monitoring (i.e., continuous ambulatory ST-segment monitoring) is an effective tool for assessing the frequency and duration of silent transient myocardial ischemia, particularly in patients who are post-acute myocardial infarction (MI), those with acute coronary syndromes (ACS), and in patients in the acute post-operative period. Holter monitoring allows for further risk stratification of patients who have a positive exercise ECG by collecting long-term ECG data on ischemic and arrhythmic events while patients perform routine activities. Both the presence and increased duration of transient ischemia as detected by continuous ST-segment Holter monitoring are associated with increased rates of coronary events and mortality. Holter monitoring may aid in the identification of patients and subgroups of patients with ACS who may derive the greatest benefit from antiplatelet and antithrombotic therapy. Indeed, many ongoing and upcoming trials of pharmacotherapy include ischemia on Holter monitoring as an endpoint.
authors.affiliation: PERFUSE Core Laboratory and Data Coordinating Center, Harvard Medical School, 350 Longwood Avenue, First floor, Boston, MA 02115, USA. mgibson@perfuse.org
authors.forename: C Michael
authors.initials: CM
authors.lastname: Gibson
authors.forename: Lauren N
authors.initials: LN
authors.lastname: Ciaglo
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Southard
authors.forename: Shaun
authors.initials: S
authors.lastname: Takao
authors.forename: Caitlin
authors.initials: C
authors.lastname: Harrigan
authors.forename: Jason
authors.initials: J
authors.lastname: Lewis
authors.forename: Jason
authors.initials: J
authors.lastname: Filopei
authors.forename: Michelle
authors.initials: M
authors.lastname: Lew
authors.forename: Sabina A
authors.initials: SA
authors.lastname: Murphy
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Buros
mesh_terms: D015716:Electrocardiography, Ambulatory / Q000379:methods*; D005080:Exercise Test; D006801:Humans; D009203:Myocardial Infarction; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000188:drug therapy; D011379:Prognosis