[Silent ischemic cardiopathy: a study with dynamic electrocardiogram and ergometric test]

Ninety-two patients with effort angina were retrospectively studied to define the prevalence, the daily distribution and the prognostic value of silent ischemic attacks. All patients had positive Holter monitoring and exercise test; coronary angiography, performed in 75/92 patients, showed 1, 2 or 3-vessels disease. Six hundred ninety-three ischemic episodes, 481 (69.5%) silent and 212 (30.5%) symptomatic, were recorded by Holter monitoring, with the highest incidence in the morning; 74/92 patients (80%) showed silent ischemic attacks. Mean duration of the symptomatic and silent ischemic attacks was respectively 9.8 +/- 5.2 and 6.4 +/- 4.2 min (p less than 0.0001); mean ST-segment depression was respectively 2.8 +/- 1.2 and 2.3 +/- 0.8 mm (p less than 0.0001). During exercise testing 86 patients (93%) had both chest pain and ST-segment changes, 2 patients (2%) only angina and 4 patients (5%) only ST-segment depression. Mean heart rate at onset of ischemia was higher during exercise testing compared with Holter monitoring (119 +/- 20 vs 95 +/- 22 b/min; p less than 0.0001). No significant difference was shown between patients with and without silent ischemia about the prevalence of 1, 2 and 3-vessels disease; 1-year cardiovascular mortality in the 2 groups of patients was respectively 6.8% and 5.5% (p:NS). In patients with effort angina, silent ischemia has not a poor prognostic value; Holter monitoring is very useful to the correct assessment of these patients.