Silent ischaemia in asymptomatic 'healthy' individuals with coronary risk factors
A Osterspey1, I Treis-Müller, H Günther
1Medical Clinic III, University of Cologne, Army Hospital, Hamm, F.R.G.
Insights
Routine screening for silent myocardial ischemia in individuals with coronary risk factors found that ECG tests had comparable results. However, pathological ECG findings were only partly confirmed by thallium imaging.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Preventive Medicine
Background:
- Coronary risk factors increase the likelihood of cardiovascular events.
- Silent myocardial ischemia often goes undetected without specific screening.
- Early detection of ischemia is crucial for timely intervention.
Purpose of the Study:
- To evaluate the prevalence of silent myocardial ischemia in individuals with coronary risk factors.
- To compare the diagnostic yield of exercise testing and Holter monitoring for ischemia.
- To assess the correlation between ECG findings and thallium myocardial imaging results.
Main Methods:
- Screening of 1100 individuals with coronary risk factors.
- Exercise ECG testing and 24-hour Holter monitoring were performed on 256 individuals.
- Thallium myocardial imaging was conducted on a subset of individuals with positive ECG tests.
Main Results:
- 5.5% of individuals showed a pathological exercise test, and 7.4% had Holter ECG events suggestive of ischemia.
- 11.3% had at least one abnormal ECG test, while only 1.6% had positive results on both.
- Thallium imaging confirmed ischemia in only 3 out of 13 individuals with positive ECG findings.
Conclusions:
- Exercise ECG and Holter monitoring yield comparable results for detecting ischemia in this population.
- ECG abnormalities were only partially validated by thallium myocardial imaging.
- Further follow-up is needed to determine the prognostic significance of identified ECG changes.
Abstract:
On the occasion of a routine medical check-up 256 out of 1100 individuals with an accumulation of coronary risk factors were screened for silent myocardial ischaemia by exercise testing and Holter monitoring. Of these individuals 5.5% had a pathological exercise test, 7.4% had ischaemia-like events on the Holter ECG, 11.3% had at least one pathological test, but only 1.6% had ischaemic signs in both ECG tests. The outcome of the ECG tests appears to be independent of the type and the total number of risk factors. To date, 13 of the 29 individuals with a positive test have undergone thallium myocardial imaging: only three individuals had signs of ischaemia. Holter monitoring and exercise ECG show comparable results in this population. The pathological ECG findings were only partly confirmed by the thallium test. The follow-up will show the prognostic significance of the ECG changes.
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