Characterization and long-term prognosis of patients with effort-induced silent myocardial ischaemia
F Romeo1, G M Rosano, E Martuscelli
1Department of Cardiology II, University La Sapienza of Rome, Italy.
Insights
Silent myocardial ischemia (SI) during exercise testing (ET) is more common in patients with recent symptoms, diabetes, and low-workload positive ET. However, long-term prognosis and sudden death rates are similar for both painful and painless ischemia during ET.
Area of Science:
- Cardiology
- Exercise Physiology
Background:
- Coronary Artery Disease (CAD) diagnosis often involves exercise testing (ET).
- Silent Ischemia (SI) during ET, characterized by electrocardiographic changes without angina, requires prognostic evaluation.
- Understanding SI's clinical correlates and prognostic significance is crucial for patient management.
Purpose of the Study:
- To evaluate the anatomo-clinical correlations of SI during ET.
- To determine the prognostic significance of SI in patients with proven CAD.
- To compare outcomes between patients with and without SI during exercise testing.
Main Methods:
- Study included 406 patients with angiographically proven CAD and positive ET.
- Patients were categorized into Group A (positive ET with angina) and Group B (SI during ET).
- Follow-up analysis assessed mortality and sudden death rates, with multivariate analysis for prognostic factors.
Main Results:
- SI during ET was associated with higher incidence of diabetes mellitus, recent symptom onset, and positive ET at low workload.
- Long-term mortality rates were similar between groups (8.6% vs 8.2%).
- Incidence of sudden death was also comparable (2.9% vs 2.06%).
Conclusions:
- Patients with recent symptoms, diabetes, and low-workload positive ET are more prone to SI during exercise testing.
- Prognosis and sudden death risk are similar for both painful and painless myocardial ischemia during ET.
- Left ventricular function, prior myocardial infarction, and multivessel disease are independent predictors of poor prognosis in both groups.
Abstract:
The aim of this study was to evaluate the anatomo-clinical correlations and the prognostic significance of silent myocardial ischaemia (SI) during exercise testing (ET). Four hundred and six patients with angiographically proven CAD and positive ET were studied. Patients were divided into two groups: 309 patients (Group A) with positive ET for both electrocardiographical findings and angina, and 97 patients (Group B) with positive ET for electrocardiographical findings but not for angina (SI). In Group A the following clinical characteristics differed significantly from Group B: incidence of diabetes mellitus (15.8% vs 27.8%, P less than 0.04); duration of disease (less than 1 month from its first manifestation) (30.4% vs 54.6%, P less than 0.001) and a positive ET at low work-load (41.7% vs 50.5%, P less than 0.05). Mortality during follow-up (mean 72 +/- 11 months) was 8.6% in Group A and 8.2% in Group B (NS). Incidence of sudden death was similar in the two groups (2.9% vs 2.06%; NS). The multivariate analysis shown as independent variables, related significantly with a poor prognosis in both groups: left ventricular function (P less than 0.0001); prior myocardial infarction (P less than 0.0001); and multivessel disease (P less than 0.001). In conclusion, patients with a recent onset of symptoms, a positive ET at low workload and diabetes mellitus are more likely to present SI during ET. The long-term prognosis and the incidence of sudden death are similar in patients with painful and painless myocardial ischaemia during ET.
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