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Transient ST-segment depression during holter monitoring in normal population
108A
JKC Vol. 15, No. 2 February 1990:108A
ABSTRACTS
LY LIFE ITS
Patients with coronaryarterydisease( circadian and short-term variationin the silentischemia(SI)duringdailylife.Ho occurrence of variationin magnitudeof SI time intervals and its relationto variati threshold(IT) as assessedby exercisetre IETT)are unknown.To addressthese issues CAD its with ambulatory ECG monitoring and ETT at initial and aftera laean follow-upof 12&3 __..-.- evaluation -.months(ranqe6-22)durinqwhichno acuteeventsor changes-in Symptomsoccurred. All studieswere performed ithdrawal of medications. IT was assessedas time of exercise to Inm STa. numberof ischemicepis 48-hourambulatory ECG totalof 96 ischemic 84% were si nitoring; rangedfrom 1 to 19. with the numberof isch most recentevaluations Afterfollow-up, 13 pts magnitude of SI. This variationin the magnitudeof SI significantly correlated ith the changesobservedin IT (r= -0.73;pcO.0005). Thus, in pts with stableCAD, the magnitude of SI duringdailylifemay show significant variation duringlongitudinal evaluation. Wore importantly, the occurrence and magnitudeof this variationis linkedto parallelchangesin the IT, and therefore can be predictedby assessment of the conventional stresstest.
SIEMT S WRf#G HOLTER TORINGIW M.D._D.Andresen,M.D., Th.BriIggemann, M.Sc., reczek.H.0~. B. Becker,M.D., R. Schriider,M.D.,FACC Dept.of Cardiopulmology, KlinikumSteglitz,BerlinFRG WhethertransientST-segmentdepression(ST41during 24-h Holtermonitoring(HM) in patientswith coronary arterydisease(CAD) is alwaysa marker of myocardial ischemiadependson how oftenST1 will be observedin normalsubjects(subs).Becauseof inadequatedefinition of "normalpopulation", previousresultsare contradictory.m: We studied116 apparentlyhealthy subs screenedby questionnaire, 12,leadECG, PD-ECHO, and symptomlimitedbicycleexercisetest. 32 had to be excluded(19 mitralvalveprolapse,10 hypertension, 2 posturalSTl, 1 abnormalexercisetest). The remaining 84 subs (36 m, 48 f; mean age 45.1) underwentHM in order to assessthe extent,frequencyand duration of ST1 (20.1 mV; ~1 min). Resulti:6184 subs (7.1%) had horizontalor down-slopingST1 (mean: 0.20 mV); mean numberof episodes:4 Cl-19)/24h; mean duration 12.2 (150131)/min. These 6 subs underwent exercise thallium-201 imaging(2 pas, 4 nes results).Coronarv angiography was performedin the 2 pos subs and wa; negativein both. __m: Even in carefullyselectednormal subs. ST=segmentdepressioncould be documentedby Holter monitoring. Neitherthe extent,nor the frequency,nor the durationof episodesofferscriteriato differentiate betweentrue silentischemiaand a false-positive result.Thus, ST-segmentanalysisby HM shouldnot be used as a screeningmethod for detectionof CAD in asymptomatic patients.However,even when evaluating transientST-depressionduring Holtot monitoringin patientswith CAD, a certainamountaf false positive resultsmust bc considered.
SI (~82) %3* 15sf20*2@+ Sx (rF70) 723 13
CALCULATION OF ORIFICEAREA USINGCOLORDOPPLERPROXIMAL ISOVELOCITY SURFACEAREA
F.A.C.C.,University of Californiafjafdril
It is oftenimportantto estimatethe orificearea in valvularstenosisor septaldefect. e evaluateda new colorDopplermethodfor calculating orificearea based on identifying a red-bluealiasinginterface proximalto the orifice,corresponding to a proximalisovelocity surfacearea(PISA).Volumeflow rate(FR)can be calculatedas PISA x isovelocity and orificeareaFR/Continuous Wave jet velocity/A(A: experimentallydeterminedcontraction coefficienta.62). We evaluated this methodin 7 conditions with orifices=.2850 1.13, and 2.01 cd. FR was variedfrom .4 to 22 L/t& ior constantflow and from .5 to 12 L/minfor pulsatileflow. Long and short-axis color Dopplerimagesproximalto the orificeand CW Dopplerof distaljet were recorded. PISA was calculated usinghemielliptical model. Besultz: Calculated orificearea usingthe PISA method correlated well with actualarea for both constantflow (r-0.99,mean Xdifferencem 8.4%) and pulsatileflow (r=O.gS,mean %ii;T;rence=;.2%). ACl, (LCa culatedArea (cm21 13 2. Constant :: 02 1 06: 04 I.:;:12 Pulsatile 5i:o3 1:09~:05 1' Co clusiong:ColorDopplerPISA method esiimating orificearea over a rangeapp valvularstenosisand septaldefects. This methodmay be a usefulalternative for estimating valvearea and defect size.
JKC Vol. 15, No. 2 February 1990:108A
ABSTRACTS
LY LIFE ITS
Patients with coronaryarterydisease( circadian and short-term variationin the silentischemia(SI)duringdailylife.Ho occurrence of variationin magnitudeof SI time intervals and its relationto variati threshold(IT) as assessedby exercisetre IETT)are unknown.To addressthese issues CAD its with ambulatory ECG monitoring and ETT at initial and aftera laean follow-upof 12&3 __..-.- evaluation -.months(ranqe6-22)durinqwhichno acuteeventsor changes-in Symptomsoccurred. All studieswere performed ithdrawal of medications. IT was assessedas time of exercise to Inm STa. numberof ischemicepis 48-hourambulatory ECG totalof 96 ischemic 84% were si nitoring; rangedfrom 1 to 19. with the numberof isch most recentevaluations Afterfollow-up, 13 pts magnitude of SI. This variationin the magnitudeof SI significantly correlated ith the changesobservedin IT (r= -0.73;pcO.0005). Thus, in pts with stableCAD, the magnitude of SI duringdailylifemay show significant variation duringlongitudinal evaluation. Wore importantly, the occurrence and magnitudeof this variationis linkedto parallelchangesin the IT, and therefore can be predictedby assessment of the conventional stresstest.
SIEMT S WRf#G HOLTER TORINGIW M.D._D.Andresen,M.D., Th.BriIggemann, M.Sc., reczek.H.0~. B. Becker,M.D., R. Schriider,M.D.,FACC Dept.of Cardiopulmology, KlinikumSteglitz,BerlinFRG WhethertransientST-segmentdepression(ST41during 24-h Holtermonitoring(HM) in patientswith coronary arterydisease(CAD) is alwaysa marker of myocardial ischemiadependson how oftenST1 will be observedin normalsubjects(subs).Becauseof inadequatedefinition of "normalpopulation", previousresultsare contradictory.m: We studied116 apparentlyhealthy subs screenedby questionnaire, 12,leadECG, PD-ECHO, and symptomlimitedbicycleexercisetest. 32 had to be excluded(19 mitralvalveprolapse,10 hypertension, 2 posturalSTl, 1 abnormalexercisetest). The remaining 84 subs (36 m, 48 f; mean age 45.1) underwentHM in order to assessthe extent,frequencyand duration of ST1 (20.1 mV; ~1 min). Resulti:6184 subs (7.1%) had horizontalor down-slopingST1 (mean: 0.20 mV); mean numberof episodes:4 Cl-19)/24h; mean duration 12.2 (150131)/min. These 6 subs underwent exercise thallium-201 imaging(2 pas, 4 nes results).Coronarv angiography was performedin the 2 pos subs and wa; negativein both. __m: Even in carefullyselectednormal subs. ST=segmentdepressioncould be documentedby Holter monitoring. Neitherthe extent,nor the frequency,nor the durationof episodesofferscriteriato differentiate betweentrue silentischemiaand a false-positive result.Thus, ST-segmentanalysisby HM shouldnot be used as a screeningmethod for detectionof CAD in asymptomatic patients.However,even when evaluating transientST-depressionduring Holtot monitoringin patientswith CAD, a certainamountaf false positive resultsmust bc considered.
SI (~82) %3* 15sf20*2@+ Sx (rF70) 723 13
CALCULATION OF ORIFICEAREA USINGCOLORDOPPLERPROXIMAL ISOVELOCITY SURFACEAREA
F.A.C.C.,University of Californiafjafdril
It is oftenimportantto estimatethe orificearea in valvularstenosisor septaldefect. e evaluateda new colorDopplermethodfor calculating orificearea based on identifying a red-bluealiasinginterface proximalto the orifice,corresponding to a proximalisovelocity surfacearea(PISA).Volumeflow rate(FR)can be calculatedas PISA x isovelocity and orificeareaFR/Continuous Wave jet velocity/A(A: experimentallydeterminedcontraction coefficienta.62). We evaluated this methodin 7 conditions with orifices=.2850 1.13, and 2.01 cd. FR was variedfrom .4 to 22 L/t& ior constantflow and from .5 to 12 L/minfor pulsatileflow. Long and short-axis color Dopplerimagesproximalto the orificeand CW Dopplerof distaljet were recorded. PISA was calculated usinghemielliptical model. Besultz: Calculated orificearea usingthe PISA method correlated well with actualarea for both constantflow (r-0.99,mean Xdifferencem 8.4%) and pulsatileflow (r=O.gS,mean %ii;T;rence=;.2%). ACl, (LCa culatedArea (cm21 13 2. Constant :: 02 1 06: 04 I.:;:12 Pulsatile 5i:o3 1:09~:05 1' Co clusiong:ColorDopplerPISA method esiimating orificearea over a rangeapp valvularstenosisand septaldefects. This methodmay be a usefulalternative for estimating valvearea and defect size.