The clinical significance of continuous ECG (ambulatory ECG or Holter) monitoring of the ST-segment to evaluate ischemia: a review.
Silent ischemia is a common manifestation of coronary artery disease (CAD). Continuous ECG (cECG) monitoring is an effective tool for assessing the frequency and duration of silent ischemic episodes for patients with CAD and for risk stratifying asymptomatic patients or those after an acute coronary syndrome by identifying those at increased risk for future cardiovascular events or death. cECG also allows monitoring of the effectiveness of therapy in patients with CAD. Treatment strategies targeted toward the elimination of silent ischemia have shown that revascularization was better than medical therapy in eliminating silent ischemia, but large scale, prospective studies targeting silent ischemia as a treatment endpoint are still lacking. Future research is warranted to study the effects of newer medical agents or the selected use of revascularization in those patients with persistent silent ischemia despite current medical regiments.
Division of Cardiovascular Medicine, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
Neil J
NJ
Wimmer
Benjamin M
BM
Scirica
Peter H
PH
Stone
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology; D015716:Electrocardiography, Ambulatory; D006801:Humans; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D009204:Myocardial Revascularization; D011379:Prognosis; D018570:Risk Assessment
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers
AECG; Ambulatory electrocardiography; CAD; Continuous electrocardiography; Holter; NSTEMI; PCI; RCT; ST-segment elevation myocardial infarction; STEMI; Silent ischemia; ambulatory electrocardiogram; cECG; continuous electrocardiogram; coronary artery disease; non-ST-segment elevation myocardial infarction; percutaneous coronary intervention; randomized clinical trial