Silent Myocardial Ischemia After Myocardial Infarction: Severity of Coronary Artery Disease,Impact on Left Ventricular Systolic and Diastolic Functions and Prognosis
Restricted accessResearch articleFirst published online June, 1998
Silent Myocardial Ischemia After Myocardial Infarction: Severity of Coronary Artery Disease,Impact on Left Ventricular Systolic and Diastolic Functions and Prognosis
The aim of the present study was assessment of the relationship of silent myocardial ischemia with clinical, coronary angiography findings, and left ventricular systolic and diastolic function, and its prognostic significance in patients early after myocardial infarc tion. One hundred nineteen male patients (mean age 48.2 ± 1.2 years) with first Q wave myocardial infarction entered the study. Routine coronary angiography, 24-hour Holter electrocardiographic recordings, and two-dimensional and Doppler echocardiography with assessment of left ventricular systolic and diastolic function were performed in all the patients. Prospective follow-up was done during 1 year. Patients with signs of silent myocardial ischemia early after myocardial infarction had more severe coronary artery disease, pronounced disturbances of left ventricular systolic and diastolic performance, and adverse prognosis than those without ischemia appearance during Holter recordings.
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References
1.
Taylor G., Humphries J., Mellits O., et al: Predictors of clinical course, coronary anatomy and ventricular function after recovery from acute myocardial infarctionCirculation62:960-969, 1980.
2.
Nishmura R., Reeder G., Miller F., et al: Prognostic value of predischarge two-dimensional echocardiograph and hemodynamic measurements on admisson with acute myocardial infarctionAm J Cardiol53: 429-432, 1984.
3.
Bhatnagar S. , Moussa M., Al-Yusuf A.: The role of pre-hospital discharge two-dimensional echocardiography in determining the prognosis of survivors of first myocardial infarctionAm J Cardiol60:10-14, 1987.
4.
Bigger J., Fleiss J., Kleiger R., et al: The relationships among ventricular arrhythmias, left ventricular dysfunction and mortality in the two years after myocardial infarctionCirculation69:250-258, 1984.
5.
Bonow R., Bacharah S., Green S., et al: Prognostic implications of symptomatic versus asymptomatic (silent) myocardial ischemia induced by exercise in mildly symptomatic and in asymptomatic patients with angiographically documented coronary artery diseaseAm J Cardiol60:778-783, 1987.
6.
Weiner D., Ryan T., McCabe H., et al: Significance of silent myocardial ischemia during exercise testing in patients with coronary artery diseaseAm J Cardiol59:725-729, 1987.
7.
Ouang P., Chandra N., Gottlieb S.: Frequency and importance of silent myocardial ischemia identified with ambulatory electrocardiographic monitoring in the early in-hospital period after acute myocardial infarctionAm J Cardiol65:267-270, 1990.
8.
Quintana M., Lindvall K., Brolund F., et al: Prognostic value of exercise stress testing versus ambulatory electrocardiography after acute myocardial infarction : A 3-year follow-up studyCoron Art Dis6 :865-875, 1995.
9.
Quintana M., Lindvall K., Carlens P., et al: ST-segment depression on ambulatory electrocardiography in the early in-hospital period after acute myocardial infarction predicts early and late mortality: A short-term and a 3-year follow-up periodClin Cardiol26: 392-400, 1995.
10.
Wagner G., Freye C., Palmeri S.: Evaluation of a QRS scoring system for estimating myocardial infarction size: 1. Specificity and observer agreementCirculation65:342-347, 1982.
11.
Kennedy J., Trenholme S., Kasser I.: Left ventricular volume and mass from single-plane cineangiogram. A comparison of anteroposterior and anterior oblique methodsAm Heart J80:343-347, 1970.
12.
Fuji J., Yazaki Y., Aizawa T., et al: Noninvasive assessment of left and right ventricular filling in myocardial infarction with a two-dimensional Doppler echocardiographic methodJ Am Coll Cardiol5:1155-1160, 1985 .
13.
Aoyage T., Pouleur H., Eyle C., et al: Left ventricular filling and wall motion asynchrony in myocardial infarctionJ Am Coll Cardiol17:84A, 1991 .
14.
Gilbert J., Glantz S.: Determinants of left ventricular filling and of the diastolic pressure-volume relationCirc Res64:827-852, 1987.
15.
Serizawa T. , Vogel W., Apstein C., et al: Comparison of acute alterations in left ventricular relaxation and diastolic chamber stiffness induced by hypoxia and ischemiaJ Clin Invest68:91-102, 1991.
16.
Bourdillon P. , Paulus W., Serizawa T., et al: Effects of verapamil on regional myocardial diastolic function in pacing-induced ischemia in dogsAm J Physiol251:834-840, 1986.
17.
Myreng G., Myhre E.: Effects of verapamil on left ventricular relaxation and filling dynamics in coronary artery disease: A study by pulsed Doppler echocardiographyAm Heart J117:870-875, 1989.
18.
Snow F., Gorcsan G., Lewis S., et al: Doppler echocardiographic evaluation of left ventricular diastolic function after percutaneous transluminal coronary angioplasty for unstable angina pectoris annd acute myocardial infarctionAm J Cardiol65:840-844, 1990.
19.
Iliceto S., Amigo A., Marangelli V., et al : Doppler echocardiographic evaluation of the effect of the atrial pacing-induced ischemia on left ventricular filling in patients with coronary artery diseaseJ Am Coll Cardiol11:953-961, 1989.
20.
Mehta H., Bennet D.: Impaired left ventricular function in acute myocardial infarcion assessed by Doppler measurement of ascending blood velocity and maximum accelerationAm J Cardiol57:1052-1058, 1986 .
21.
Bryg R., Labovitz A., Mehdirad A., et al: Effect of coronary artery disease on Doppler-derived parameters of aortic flow during up-right exerciseAm J Cardiol58:14-19, 1986.
22.
Hirzel H., Lentmyler R., Kraenbuehl H.: Silent myocardial ischemia: Hemodynamic changes during dynamic exercise in patients with proven coronary artery disease despite absence of angina pectorisJ Am Coll Cardiol6:275-284, 1989.
