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Asymptomatic electrocardiographic ischemia and silent myocardial ischemia
V Ionescu1, N Moraru, M Târlea
1D. Danielopolu Institute for Normal and Pathological Physiology, Bucharest, Romania.
Insights
Silent myocardial ischemia, a common cardiovascular issue, showed varied outcomes over ten years. While men had slightly higher adverse events, women experienced significantly more improvements in electrocardiographic and clinical symptoms.
Area of Science:
- Cardiology
- Internal Medicine
- Epidemiology
Background:
- Silent myocardial ischemia is a prevalent cardiovascular disease, often overlooked in classifications focusing on angina and myocardial infarction.
- Despite its significance, understanding the long-term prognosis of initially asymptomatic electrocardiographic ischemia requires further investigation.
Purpose of the Study:
- To investigate the ten-year follow-up outcomes of initially asymptomatic electrocardiographic ischemia.
- To compare the incidence of adverse events and improvements between males and females with silent myocardial ischemia.
Main Methods:
- A ten-year (1976-1986) follow-up study of 56 patients with initially asymptomatic electrocardiographic ischemia.
- Analysis of electrocardiographic localization, clinical evolution, and patient demographics.
Main Results:
- Overall, 26.6% of patients experienced worsening, 23.2% improved, and 21.5% remained unchanged over ten years.
- Males showed a slightly higher incidence of unfavorable outcomes (myocardial infarction, angina, arrhythmias) compared to females.
- Women experienced significantly more frequent electrocardiographic and clinical improvements (4 times more likely) than men (p < 0.002).
Conclusions:
- Silent myocardial ischemia has a variable long-term prognosis, with a notable proportion experiencing clinical or electrocardiographic changes.
- Gender influences the course of silent ischemia, with women demonstrating a better capacity for improvement compared to men.
- Further research is warranted to understand the underlying mechanisms and optimize management strategies for silent myocardial ischemia.
Abstract:
Silent myocardial ischemia is undoubtedly the second most prevalent cardiovascular disease after arterial hypertension. Considering its statistical and social importance, the authors, while admitting the less specific coronary character of this entity, do not agree with its being omitted from the last classification of coronary disease (1979), in which especially/angina pectoris and myocardial infarction are emphasized. In the present paper, which opens up an investigation into initially silent ischemia carried out on a great number of cases, the authors discuss the preliminary observations derived from a ten-year (1976-1986) follow up of 56 cases of initially asymptomatic electrocardiographic ischemia with an electric localization suggesting specific coronary territories. It results that the incidence of an unfavourable evolution (myocardial infarction, angina pectoris, onset of arrhythmias or conduction defects) is somewhat higher in males than in females, but not up to 3-4 times as stated in most populational studies on myocardial infarction. The electrocardiographic and clinical improvements are, however, definitely more frequent (4 times) in women than in men (p less than 0.002). Of the 56 cases studied, 26.6% worsened, 23.2% improved, and 21.5% presented no change along the 10 years of follow up (the others showed electrocardiographic evolutions without a clinical expression, while 2 died from a noncardiac cause.