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Ambulatory myocardial ischaemia in stable angina
1Department of Cardiology, Middlesex Hospital, London.
Insights
Ambulatory myocardial ischemia, detected by Holter monitoring, lacks clear clinical significance despite decades of study. Evidence does not yet justify routine detection and treatment in stable angina patients.
Area of Science:
- Cardiology
- Clinical Medicine
Background:
- Ambulatory ST segment depression episodes are common in stable angina.
- The clinical significance and prognostic value of these episodes remain debated.
- No consensus exists on the utility of detecting and treating these events.
Purpose of the Study:
- To review the prevalence of ambulatory myocardial ischemia in stable angina.
- To assess the reported prognostic importance of these ischemic episodes.
- To evaluate the evidence supporting the detection and treatment of ambulatory ischemia.
Main Methods:
- Systematic review of studies on Holter monitoring in stable angina.
- Analysis of data on the prevalence and prognosis of ST segment depression.
- Evaluation of treatment strategies for ambulatory myocardial ischemia.
Main Results:
- Prevalence data on ambulatory ischemia are variable.
- Prognostic significance of detected episodes is not consistently established.
- Evidence to justify routine detection and treatment is currently insufficient.
Conclusions:
- The clinical impact of ambulatory myocardial ischemia in stable angina requires further investigation.
- Current evidence does not support routine screening or intervention based solely on Holter findings.
- Further research is needed to clarify the role of ambulatory ischemia monitoring in patient management.
Abstract:
Episodes of ischaemic ST segment depression detected by continuous ambulatory electrocardiographic (Holter) monitoring have been extensively investigated for over two decades, but no consensus has emerged about their clinical significance. This review examines the prevalence and reported prognostic importance of ambulatory myocardial ischaemia in patients with stable angina, and discusses whether or not detection and treatment of ischaemic episodes in ambulant angina patients can be justified on the basis of the available evidence.