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[Painless ST segment depression during exercise stress tests in patients after acute myocardial infarct]
Insights
Patients with painless ST-segment depression during exercise tests had more frequent diabetes and worse left ventricular function. This highlights key differences in patient profiles and cardiac health.
Area of Science:
- Cardiology
- Exercise Physiology
Context:
- Exercise electrocardiogram (ECG) testing is crucial for diagnosing ischaemic heart disease.
- ST-segment depression on exercise ECG indicates myocardial ischaemia.
- Understanding the clinical significance of symptomatic versus asymptomatic ischaemia is vital.
Purpose:
- To investigate the clinical characteristics and left ventricular function in patients exhibiting ST-segment depression during exercise testing, comparing those with and without anginal pain.
Summary:
- Of 400 patients, 125 showed ischaemic ST-segment depression (≥1 mm) on exercise ECG.
- Among these, 66.4% experienced anginal pain, while 33.6% were asymptomatic.
- Patients with painless ST-segment depression had a higher prevalence of diabetes mellitus and more deteriorated left ventricular function (PEP/LVET ratio) compared to symptomatic patients.
- No significant differences were observed in sex, age, arterial hypertension, peak exercise heart rate, or magnitude of ST-segment depression.
Impact:
- Identifies distinct patient subgroups within exercise-induced ST-segment depression.
- Suggests that painless ischaemia may be associated with poorer left ventricular function and a higher comorbidity burden (diabetes).
- Informs clinical risk stratification and management strategies for patients undergoing exercise ECG testing.
Abstract:
A group of 125 patients (of the total of 400 patients) had ischaemic ST-segment depression (greater than or equal to 1 mm) on exercise electrocardiogram. Of 125 patients with ischaemic response on exercise electrocardiogram 83 (66.4%) patients had both ST-segment depression and anginal pain, and 43 (33.6%) patients were without ischaemic symptoms during exercise testing. There was no difference with regard to sex and age between patients with and without anginal pain. There was no difference in frequency of arterial hypertension, but diabetes mellitus was more frequent in patients with painless ST-segment depression than in patients with painful ST-segment depression. Left ventricular function was more deteriorated in patients with painless ST-segment depression (PEP/LVET = 0.390 +/- 0.028) than in symptomatic patients (PEP/LVET = 0.366 +/- 0.042; P/0.001). There was no difference in heart rate on peak exercise and in magnitude of ST-segment depression in patients with and without anginal pain.