Clinical significance of exercise-induced silent myocardial ischemia in patients with coronary artery disease

Exercise-induced silent myocardial ischemia is a frequent feature in patients with coronary artery disease. The purpose of this study was to compare the clinical and angiographic characteristics of 269 patients who complained of chest pain during an exercise test (group I) with those of 204 who developed exercise-induced silent myocardial ischemia (group II). Group I patients more frequently had anginal symptoms of class III and IV of the Canadian Cardiovascular Society than did group II patients, who had milder symptoms (p less than 0.001). The only angiographic difference observed between the two groups was a slightly but significantly higher left ventricular end-diastolic pressure in group II patients (p less than 0.05), who also showed a longer exercise duration (p less than 0.01) with a higher heart rate-systolic pressure product (p less than 0.01) and more pronounced ST segment depression at peak exercise (p less than 0.001). Moreover, ventricular ectopic beats during exercise were more frequently observed in group II patients (p less than 0.05). Coronary bypass surgery was performed in 45% of patients of group I and in 24% of patients of group II (p less than 0.05). Survival curves of medically treated patients did not show any statistically significant difference between the two groups. Thus, although patients with a defective anginal warning system may have more pronounced signs of myocardial ischemia and a greater incidence of ventricular arrhythmias during exercise, their long-term prognosis is not different from that of patients who are stopped by angina from the activity that is inducing myocardial ischemia.

This article has been cited by other articles:

				J. A. Laukkanen, T. H. Makikallio, R. Rauramaa, and S. Kurl Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men: a population-based follow-up study Eur. Heart J., March 1, 2009; 30(5): 558 - 565. [Abstract] [Full Text] [PDF]

				A. Sajadieh, O. W. Nielsen, V. Rasmussen, H. O. Hein, and J. F. Hansen Prevalence and prognostic significance of daily-life silent myocardial ischaemia in middle-aged and elderly subjects with no apparent heart disease Eur. Heart J., July 2, 2005; 26(14): 1402 - 1409. [Abstract] [Full Text] [PDF]

				S. Kurl, J.A. Laukkanen, T.-P. Tuomainen, R. Rauramaa, T.A. Lakka, R. Salonen, J. Eranen, J. Sivenius, and J.T. Salonen Association of Exercise-Induced, Silent ST-Segment Depression With the Risk of Stroke and Cardiovascular Diseases in Men Stroke, July 1, 2003; 34(7): 1760 - 1765. [Abstract] [Full Text] [PDF]

				C. Gazzaruso, A. Garzaniti, S. Giordanetti, C. Falcone, E. De Amici, D. Geroldi, and P. Fratino Assessment of Asymptomatic Coronary Artery Disease in Apparently Uncomplicated Type 2 Diabetic Patients: A role for lipoprotein(a) and apolipoprotein(a) polymorphism Diabetes Care, August 1, 2002; 25(8): 1418 - 1424. [Abstract] [Full Text] [PDF]

				J. A. Laukkanen, S. Kurl, T. A. Lakka, T.-P. Tuomainen, R. Rauramaa, R. Salonen, J. Eranen, and J. T. Salonen Exercise-induced silent myocardial ischemia and coronary morbidity and mortality in middle-aged men J. Am. Coll. Cardiol., July 1, 2001; 38(1): 72 - 79. [Abstract] [Full Text] [PDF]

				C. Gazzaruso, A. Garzaniti, P. Buscaglia, G. Bonetti, C. Falcone, P. Fratino, G. Finardi, and D. Geroldi Association between apolipoprotein(a) phenotypes and coronary heart disease at a young age J. Am. Coll. Cardiol., January 1, 1999; 33(1): 157 - 163. [Abstract] [Full Text] [PDF]

				C. Gazzaruso, A. Garzaniti, P. Buscaglia, G. Bonetti, C. Falcone, P. Fratino, G. Finardi, and D. Geroldi Apolipoprotein(a) Phenotypes and Their Predictive Value for Coronary Heart Disease: Identification of an Operative Cut-Off of Apolipoprotein(a) Polymorphism European Journal of Cardiovascular Prevention & Rehabilitation, February 1, 1998; 5(1): 37 - 42. [Abstract] [PDF]

				C. Falcone, C. Auguadro, R. Sconocchia, and L. Angoli Susceptibility to Pain in Hypertensive and Normotensive Patients With Coronary Artery Disease : Response to Dental Pulp Stimulation Hypertension, November 1, 1997; 30(5): 1279 - 1283. [Abstract] [Full Text]

				S. Ghione Hypertension-Associated Hypalgesia: Evidence in Experimental Animals and Humans, Pathophysiological Mechanisms, and Potential Clinical Consequences Hypertension, September 1, 1996; 28(3): 494 - 504. [Abstract] [Full Text]

				A. J. Moss, R. E. Goldstein, W. J. Hall, J. T. Bigger Jr, J. L. Fleiss, H. Greenberg, M. Bodenheimer, R. J. Krone, F. I. Marcus, F. J. Th. Wackers, et al. Detection and Significance of Myocardial Ischemia in Stable Patients After Recovery From an Acute Coronary Event JAMA, May 12, 1993; 269(18): 2379 - 2385. [Abstract] [PDF]

				S. R. Johansson, M. Sanez, and H. Emanuelsson Transient Myocardial Ischemia During Holter Registration Before and After Coronary Angioplasty Angiology, June 1, 1991; 42(6): 429 - 440. [Abstract] [PDF]

				C. P. Miranda, K. G. Lehmann, B. Lachterman, E. M. Coodley, and V. F. Froelicher Comparison of Silent and Symptomatic Ischemia during Exercise Testing in Men Ann Intern Med, April 15, 1991; 114(8): 649 - 656. [Abstract] [PDF]

				A. J. Barsky, B. Hochstrasser, N.A. Coles, J. Zisfein, C. O'Donnell, and K. A, Eagle Silent Myocardial Ischemia: Is the Person or the Event Silent? JAMA, September 5, 1990; 264(9): 1132 - 1135. [Abstract] [PDF]

				P. F. Cohn Silent Myocardial Ischemia Ann Intern Med, August 15, 1988; 109(4): 312 - 317. [Abstract] [PDF]