[Ambulatory ECG during screening phase in relation to other technics in patients with precordial pain]

Screening of patients with precordial symptoms is a mayor social problem. Holter monitoring is easy to use because it ambulatory, non invasive, can be repeated without harm, has no contraindications and permits prolonged monitoring. Therefore, it seemed necessary to determine the "role" of this test. We examined all of the Holter monitorings performed in Dynamic electrocardiographic laboratory of the S. Matteo Polyclinic from 1983 to 1986. 480 of the 3365 patients visited, presented precordial symptoms. 162 patients (group A) had established ischemic heart disease (old myocardial infarction and/or coronary arteriography). 318 patients (group B) had no definite diagnosis. 71 subjects from group A and 140 from group B presented a typical symptomatology. Group A showed a 31.48% positivity during the test with 165 ischemic attacks. Group B had 25.15% positivity with 397 ischemic attacks. 51 symptomatic attacks (30%) were recorded for group B. Therefore, there was a mayor incidence of silent ischemic heart disease in both groups. Results obtained comparing Holter monitoring to the bicycle ergometry exercise test and to functional test, were comparable in 56.91% (sensibility 41.71% and specificity 78.62%) in the first case and 61.38% (sensibility 42.50% and sensitivity 73.77%) in the latter. In conclusion, we believe that Holter monitoring is useful in mass screening because it permits monitoring of most ischemic attacks, whether under stress or at rest, symptomatic or silent.