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European Heart Journal 1992 13(4):457-463;
Copyright © 1992 by the European Society of Cardiology.
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© 1992 The European Society of Cardiology

Characterization and long-term prognosis of patients with effort-induced silent myocardial ischaemia

F. ROMEO, G. M. C. ROSANO, E. MARTUSCELLI, A. VALENTE and A. REALE

Department of Cardiology II, University ‘La Sapienza’ of Rome, 165 Viale del Policlinico Rome, Italy

Received 15 October 1990; revised 25 April 1991; .

Correspondence. Giuseppe M. C. Rosano, National Heart and Lung Institute, Dovehouse Street, London SW3 6LY U.K.

Abstract

The aim of this study was to evaluate the anatomo-clinical correlations and the prognostic significance of silent myocardial ischaemia (SI) during exercise testing (ET). Four hundred and six patients with angiographically proven CAD and positive ET were studied. Patients were divided into two groups: 309 patients (Group A) with positive ET for both electrocardiographical findings and angina, and 97 patients (Group B) with positive ET for electrocardiographical findings but not for angina (SI). In Group A the following clinical characteristics dffered significantly from Group B: incidence of diabetes mellitus (15.8% vs 27.8%, P<0.04); duration of disease (less than 1 month from its first manifestation) (30.4% vs 54.6%, P <0.001) and a positive ET at low work-load (41.7% vs 50.5%, P <0.05). Mortality duringfollow-up (mean 72 ± 11 months) was 8.6. in Group A and 8.2. in Group B (NS). Incidence of sudden death was similar in the two groups (2.9% vs 20.6%; NS). The multivariate analysis shown as independent variables, related significantly with a poor prognosis in both groups: left ventricular function (P<0.0001); prior myocardial infarction (P<0.0001); and multi- vessel disease (P <0.001). In conclusion, patients with a recent onset of symptoms, a positive ET at low workload and diabetes mellitus are more likely to present SI during Er. The long-term prognosis and the incidence of sudden death are similar in patients with painful and painless myocardial ischaemia during ET.

Key Words: Silent ischaemia • myocardial ischaemia • chronic stable angina • coronary artery surgery • coronary artery disease • prognosis


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