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[Diagnosis of myocardial ischemias with long-term electrocardiography: spontaneous variability and modification by
A Osterspey1, T Eggeling, C Götz
1Medizinische Klinik III, Universität Köln.
Insights
Spontaneous ST-segment changes in coronary heart disease (CHD) patients show significant day-to-day variability. Longer Holter ECG monitoring may be needed to accurately assess interventions and disease progression.
Area of Science:
- Cardiology
- Clinical Electrophysiology
- Medical Technology
Context:
- Coronary heart disease (CHD) management requires accurate assessment of myocardial ischemia.
- Ambulatory electrocardiogram (ECG) monitoring, specifically Holter ECG, is crucial for evaluating cardiac events.
- Short-acting nitrates are commonly used for acute symptom relief in CHD patients.
Purpose:
- To evaluate the spontaneous variability of ST-segment changes in patients with coronary heart disease (CHD) using Holter ECG.
- To assess the impact of sustained-release isosorbide dinitrate (ISDN) on ST-segment alterations and anginal symptoms.
Summary:
- Twenty CHD patients underwent 3-day ambulatory ECG monitoring while on short-acting nitrates.
- ST-segment alterations exhibited substantial intra-day variability (approximately 10-fold baseline).
- Sustained-release ISDN reduced anginal attacks and short-acting nitrate use, with a non-significant trend towards reduced ischemic ST changes.
Impact:
- Highlights the significant spontaneous variability of ST-segment changes in CHD, impacting diagnostic accuracy.
- Suggests that current 24-hour Holter ECG monitoring may be insufficient for capturing true ischemic burden and intervention effects.
- Emphasizes the need to consider ST-segment variability in studies of CHD progression and therapeutic interventions, potentially requiring extended monitoring periods.
Abstract:
To evaluate spontaneous variability of ST-segment changes within the Holter ECG, in 20 patients with documented coronary heart disease (CHD) long-term ambulatory ECG recordings were performed over 3 consecutive days, when the patients were only receiving short-acting nitrates. ST-segment alterations per day were measured as the area beneath the baseline (mV x min), and were compared day-to-day intraindividually. The intra-day variations of ST-segment area alterations were a factor of about 10, when compared with the baseline values. Following administrations of 120 mg ISDN ret. at the beginning of day 4, the number of anginal attacks was reduced, as was the acute medication with short-acting nitrates. There was also a trend to reduction of ischemic ST-segment changes, but these reductions could not be confirmed statistically. In studies on the course and therapeutic interventions of patients with CHD, the phenomenon of spontaneous variability of ST-segment alterations must be taken into account--as applies also to the arrhythmia analysis within the Holter ECG--and the recording period must probably be prolonged beyond the 24-h limit presently used.