Silent Myocardial Ischelllia

Edited by W. Rutishauser and H. Roskamm

With 71 Figures and 49 Tables

Springer-Verlag Berlin Heidelberg New York Tokyo 1984

Professor Dr. W. Rutishauser

Centre de Cardiologie, Hopital Cantonal Universitaire, CH-1211 Geneve 4

Professor Dr. H. Roskamm

Benedikt-Kreutz-Rehabilitationszentrum fUr Herz- und Kreislaufkranke, Slidring 15, D-7812 Bad Krozingen

ISBN-13: 978-3-540-13193-9 e-ISBN-13: 978-3-642-69589-6 DOl: lO.1007/978-3-642-69589-6

Library of Congress Cataloging in Publication Data. Main entry under title: Silent myocardial ischemia. Papers given at the International Symposium on Silent Myocardial Ischemia held in Geneva, Switzerland, May 27 -28, 1983, under the auspices ofthe European Society of Cardiology. Bibliography: p. Includes index. 1. Coronary heart disease-Congresses. 2. Ischemia-Congresses. I. Rutishauser, W. (Wilhelm), 1931- . II. Roskamm, H. (Helmut), 1933- . III. International Symposium of Silent Myocardial Ischemia (1983 : Geneva, Switzerland). IV. European Society of Cardiology. RC685.C6S537 1984 616.1'23 84-1343

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© Springer-Verlag Berlin, Heidelberg 1984

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2121/3020-543210

Preface

This book presents the papers given at the International Symposium on Silent Myocardial Ischemia held on 27 and 28 May 1983 in Geneva, Switzerland. The symposium was held under the auspices of the European Society of Car­diology, and the scientific committee was recruited from members of the working groups on angina pectoris and coronary blood flow and on myocar­dial function.

The editors want to express many thanks to all those who contributed to the success of the symposium.

W. Rutishauser H. Roskamm

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List of Contributors

R. Abbott Medical Center, School of Medicine, 720 Harrison Avenue, Boston, Massachusetts 02118, U.S.A.

G. J. Anderson Heart Station, Likoff Cardiovascular Institute, Hahnemann University, School of Medicine, 230 N. Broad Street, Philadelphia, Pennsylvania 19102, U.S.A

M. E. Bertrand Service de Cardiologie "B" et Hemodynamique, Hopital Cardiologique, 59037 Lille Cedex, France

P. Betz Rehabilitationszentrum fur Herz- und Kreislaufkranke, Slidring 15, 7812 Bad Krozingen, FRG

W. Bleifeld Abt. fur Kardiologie, II. Medizinische Klinik, Univ.-Krankenhaus Eppendorf, Martinistr. 52,2000 Hamburg 20, FRG

D. A. Bragg-Remschel Texas Heart Institute, Texas Children's Hospital, P. O. Box 20269, Houston, Texas 77225, U.S.A.

R. W Brower Thoraxcentrum/Cardiologie, Academisch Ziekenhuis, Dr. Molewaterplein 40,3015 GD Rotterdam, Netherlands

E. J. Brown, Jr. Cardiology Division, Dept. of Medicine. Health Sciences Center, State University of New York, Stony Brook, New York 11794, U.S.A.

J. R. Burton Cardio-Pulmonary Unit, National Defence Medical Centre, Ottawa, Ontario, KIA OK6, Canada

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S. Chierchia Royal Postgraduate Med. School, Hammersmith Hospital, Ducane Road, "London W12 OHS, Great Britain

J. K. Cohn Cardiology Division Dept. of Medicine, Health Sciences Center, State University of New York, Stony Brook, New York 11794, U.S.A.

P. F. Cohn Cardiology Division, Dept. of Medicine, Health Sciences Center, State University of New York, Stony Brook, New York 11794, U.S.A.

W G. Daniel Abt. fur Kardiologie, Dept. Innere Medizin, Med. Hochschule, Karl-Wiechert-Allee 9, 3000 Hannover 6, FRG

R. M Donaldson Dept. of Clinical Measurement, National Heart Hospital, Westmoreland Street, London WIM 8BA, Great Britain

C. Droste Rehabilitationszentrum fur Herz- und Kreislaufkranke, Slidring 15, 7812 Bad Krozingen, FRG

B. El-Harake Centre de Cardiologie, Hopital Cantonal Universitaire, 1211 Geneve 4, Switzerland

H.-J. Engel Abt. fur Kardiologie, Dept. Innere Medizin, Med. Hochschule, Karl-Wiechert-Allee 9, 3000 Hannover 6, FRG

J. Erikssen Medisinsk Storavdeling, Universitetskiinikk, Rikshospitalet, Pilestredet 32, Oslo 1, Norway

A. Essinger Dept. de Cardiologie, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland

D. Fa/3bender Gollwitzer-Meier-Institut, Herforder StraBe 43, 4970 Bad Oeynhausen, FRG

P. F. Fazzini Divisione di Cardiologia, Ospedale Careggi, 50100 Firenze, Italy

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G. A. Feruglio Istituto di Cardiologia, Ospedale Civile, S. Maria della Misericordia, U dine, Italy

A. Fischer Dept. de Cardiologie, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland

G. M. FitzGibbon Cardio-Puhnonary Unit, National Defence Medical Centre, Ottawa, Ontario, KIA OK6 Canada

G. C Friesinger Division of Cardiology, Dept. of Medicine, Vanderbilt University, Nashville, Tennessee 37232, U.S.A.

U. Gleichmann Gollwitzer-Meier-Institut, Herforder StraBe 43, 4970 Bad Oeynhausen, FRG

H. Gohlke Rehabilitationszentrum fur Herz- und Kreislaufkranke, Slidring 15, 7812 Bad Krozingen, FRG

J.-J. Goy Dept. de Cardiologie, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland

M. Grbic Dept. de Cardiologie, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland

R. Grossmann Abt. fur Kardiologie, Zentrum der Inneren Medizin, Klinikum der U niversiHit, Theodor-Stern-Kai 7, 6000 Frankfurt/Main 70, FRG

C W.Hamm Abt. fur Kardiologie, II. Medizinische Klinik, Univ.-Krankenhaus Eppendorf, MartinistraBe 52, 2000 Hamburg 20, FRG

A. Hinrichs Abt. fur Kardiologie, II. Medizinische Klinik, Univ.-Krankenhaus Eppendorf, MartinistraBe 52, 2000 Hamburg 20, FRG

G.Hor Abt. fur Kardiologie, Zentrum der Inneren Medizin, Klinikum der UniversiHit, Theodor-Stern-Kai 7, 6000 Frankfurt/Main 70, FRG

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P. G. Hugenholtz Thoraxcentrum/ Cardiologie, Academisch Ziekenhuis, Dr. Molewaterplein 40, 3015 GD Rotterdam, Netherlands

H. Hundeshagen Abt. fUr Nuklearmedizin, Med, Hochschule, Karl-Wiechert-Allee 9, 3000 Hannover 6, FRG

M. Kaltenbach Abt. fUr Kardiologie, Zentrum der Inneren Medizin, Klinikum der U niversitat, Theodor-Stern-Kai 7, 6000 Frankfurt/Main 70, FRG

W. B. Kannel Medical Center, School of Medicine, 720 Harrison Avenue, Boston, Massachussetts 02118, U.S.A.

W. J. Keon University of Ottawa Cardiac Unit, Ottawa Civic Hospital, Ottawa, Canada

G. Kober Abt. fUr Kardiologie, Zentrum der Inneren Medizin, Klinikum der U niversitat, Theodor-Stern-Kai 7, 6000 Frankfurt/Main 70, FRG

M. W. Kronenberg Division of Cardiology, Dept. of Medicine, Vanderbilt University, Nashville, Tennessee 37232, U.S.A.

W. Kupper Abt. fUr Kardiologie, II. Medizinische Klinik, Univ.-Krankenhaus Eppendorf, MartiniStr. 52,2000 Hamburg 20, FRG

S. P. Kutalek Heart Station, LikofI Cardiovascular Institute, Hahnemann University School of Medicine, 230 N. Broad Street, Philadelphia, Pennsylvania 19102, U.S.A.

J. M Lablanche Service de Cardiologie "B" et Hemodynamique, Hopital Cardiologique, 59037 Lille Cedex, France

P. R. Lichtlen Abt. fUr Kardiologie, Dept. Innere Medizin, Med. Hochschule, Karl-Wiechert-Allee 9, 3000 Hannover 61, FRG

F. Lombardi Istituto di Ricerche Cardiovascolari, Via Bonfadini 214, 20138 Milano, Italy

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A . MaWani Istituto di Ricerche Cardiovascolari, Via Bonfadini 214, 20138 Milano, Italy

H. Mannebach Gollwitzer-Meier-Institut, Herforder StraBe 43, 4970 Bad Oeynhausen, FRG

F. Marchi Divisione di Cardiologia, Ospedale Careggi, 50100 Firenze, Italy

F. D. Maul Abt. fur Kardiologie, Zentrum der Inneren Medizin, Klinikum der Universitat, Theodor-Stern-Kai 7, 6000 Frankfurt/Main 70, FRG

P. Moret Centre de Cardiologie, Hopital Cantonal Universitaire, 1211 Geneve 4, Switzerland

M. Pagani Istituto di Ricerche Cardiovascolari, Via Bonfadini 214, 20138 Milano, Italy

M. Payot Dept. de Cardiologie, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland

K. Peters Rehabilitationszentrum fur Herz- und Kreislautkranke, Slidring 15, 7812 Bad Krozingen, FRG

P. Pucci Divisione di Cardiologia, Ospedale Careggi, 50100 Firenze, Italy

M. Rabaeus Centre de Cardiologie, Hopital Cantonal Universitaire, 1211 Geneve 4, Switzerland

o. Ratib Centre de Cardiologie, Hopital Cantonal Universitaire, 1211 Geneve 4, Switzerland

A. F. Rickards Dept. of Clinical Measurement, National Heart Hospital, Westmoreland Street, London WIM 8BA, Great Britain

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A. Righetti Centre de Cardiologie, H6pital Cantonal Universitaire, 1211 Geneve 4, Switzerland

D. Robertson Division of Cardiology, Dept. of Medicine, Vanderbilt University, Nashville, Tennessee 37232, U.S.A.

R. M. Robertson Division of Cardiology, Dept. of Medicine, Vanderbilt University, Nashville, Teooessee 37232, U.S.A.

H. Roskamm Rehabilitationszentrum fur Herz- und Kreislautkranke, Slidring 15, 7812 Bad Krozingen, FRG

W. Rutishauser Centre de Cardiologie, H6pital Cantonal Universitaire, 1211 Geneve 4, Switzerland

L. Samek Rehabilitationszentrum fur Herz- und Kreislautkranke, Slidring 15, 7812 Bad Krozingen, FRG

G. M. Santoro Divisione di Cardiologia, Ospedale Careggi, 50100 Firenze, Italy

D. Scherer Abt. fur Kardiologie, Zentrum der Inneren Medizin, Klinikum der Universitat, Theodor-Stern-Kai 7, 6000 Frankfurt/Main 70, FR G

p. W. Serruys Thoraxcentrum/ Cardiologie, Akademisch Ziekenhuis, Dr. Molewaterplein 40, 3015 G D Rotterdam, Netherlands

U.Sigwart Dept. de Cardiologie, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland

D. S. Siscovick Dept. of General Medicine & Clinical Epidemiology, Wing C, Old Nurses Dormitory 221 H, University ofN orth Carolina, Chapel Hill, North Carolina 27514, U.S.A.

E. Steinmann Kantonsspital, Dept. Innere Medizin, Petersgraben 6, 4031 Basel, Switzerland

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P. SturzenhoJecker Rehabilitationszentrum fur Herz- und Kreislaufkranke, Slidring 15, 7812 BadKrozingen,FRG

P. Taggart Dept. of Clinical Measurement, National Heart Hospital, Westmoreland Street, London W 1 M 8BA, Great Britain

H.M. Tauer Abt. fur Kardiologie, Zentrum der Inneren Medizin, Klinikum der Universitat, Theodor-Stern-Kai 7, 6000 Frankfurt/Main 70, FRG

E. Thaulow Medisinsk Storavdeling, Universitetsklinikk, Rikshospitalet, Pilestredet 32, Oslo 1, Norway

F. A. Thieuleux Service de Cardiologie "B" et Hemodynarnique, Hopital Cardiologique, 59037 Lille Cedex, France

G. Trieb Gollwitzer-Meier-Institut, Herforder StraBe 43, 4970 Bad Oeynhausen, FRG

M. van den Brand Thoraxcentrum/Cardiologie, Academisch Ziekenhuis, Dr. Molewaterplein 40,3915 GD Rotterdam, Netherlands

T. Vellguth Rehabilitationszentrum fur Herz- und Kreislaufkranke, Slidring 15, 7812 Bad Krozingen, FRG

J. Vogt Gollwitzer-Meier-Institut, Herforder StraBe 43, 4970 Bad Oeynhausen, FRG

G. Zambaldi Divisione di Cardiologia, Ospedale Careggi, 50100 Firenze, Italy

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Table of Contents

W Rutishauser Introduction ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

P. F. Cohn Clinical Problems Concerning Asymptomatic Coronary Artery Disease ................................................... 3

A. Malliani, F. Lombardi, and M. Pagani Presence or Absence of Angina Pectoris During Myocardial Ischemia 7

C. Droste, and H. Roskamm Pain Measurement and Pain Modification by Naloxone in Patients with Asymptomatic Myocardial Ischemia ........... . . . . . . . . . . . . . . . .. 14

S. Chierchia Left Ventricular Perfusion and Function During Transient Asymptomatic ST-Segment Changes . . . . . . . . . . . . . . . . . . . . . . . . . . .. 24

U. Sigwart, M. Grbic, M. Payot, J.-J. Goy, A. Essinger, and A. Fischer Ischemic Events During Coronary Artery Balloon Obstruction. . . . .. 29

P. W Serruys, M van den Brand, R. W Brower, and P. G. Hugenholtz Left Ventricular Hemodynamics, Regional Blood Flow, and Lactate Metabolism During Balloon Occlusion: Can we Alter the Sequence of Ischemic Events? ......................................... 37

W. G. Daniel, H.-J. Engel, H. Hundeshagen, and P. R. Lichtlen Regional Myocardial Blood Flow Under Rapid Atrial Pacing in Patients With ST-Segment Depression Without Anginal Pain .. . . . . . . . . . . . .. 45

A. Hinrichs, W. Kupper, C. W. Hamm, and W. Bleifeld Detection of Silent Myocardial Ischemia in Correlation to Hemodynamic and Metabolic Data ................. . . . . . . . . . . .. 50

G. Kober, R. Grossmann, H. M. Tauer, D. Scherer, F. D, Maul, G. Hor, and M. Kaltenbach Silent Myocardial Ischemia Deduced from Improved Left Ventricular Function After Coronary Angioplasty ........................... 58

A. Holmgren Hemodynamic Sequence in Asymptomatic Exercise-Induced Ischemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 66

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U. Gleichmann, D. FqfJbender, H. Mannebach, J. Vogt, and G. Trieb Contrast Ventriculography: Wall Motion Disorder Without Angina Pectoris During Exercise-Induced Ischemia . . . . . . . . . . . . . . . . . . . . .. 71

M. W. Kronenberg, and G. C. Friesinger Exercise-Induced Abnormalities in Ventricular Function: Relationship to ST-Segment Shift and Symptoms. . . . . . . . . . . . . . . . . . . . . . . . . . . .. 78

A. Righetti, O. Ratib, B. EI-Harake, and W. Rutishauser Thallium-201 Myocardial Scintigraphy and Electrocardiographic Findings in Asymptomatic Coronary Patients During Exercise Testing 79

o. Ratib, A. Righetti, and W. Rutishauser Isotope Ventriculography During Asymptomatic Ischemia . . . . . . . . .. 84

D. A. Bragg-Remschel Problems with ST-Segment Analysis in Ambulatory ECG Monitoring Systems ...... . ............................................ 90

G. J. Anderson, and S. P. Kutalek Holter Monitor Recordings in Patients with Asymptomatic Positive Exercise Thallium-201 Defects. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 99

R. M Robertson, M. W. Kronenberg, G. C. Friesinger, and D. Robertson Silent Myocardial Ischemia in Vasotonic Angina . . . . . . . . . . . . . . . . . .. 111

P. F. Fazzini, F. Marchi, P. Pucci, G. Zambaldi, and G. M . Santoro Asymptomatic Myocardial Ischemia in Patients with Effort Angina. .. 112

R. M Donaldson, P. Taggart, and A. F. Rickards Study of the Early Electrophysiological Changes Resulting from Subendocardial Ischemia Using an Intracavitary Electrode Catheter. 117

W. B. Kannel, and R . Abbott Incidence and Prognosis of Unrecognized Myocardial Infarction: Based on 26 Years Follow-up in the Framingham Study ...... . .... 131

H. Gohlke, K. Peters, P. Betz, P. Stiirzenhojecker, E. Steinmann, T. Vellguth, and H. Roskamm Angiography in Patients with Silent Myocardial Infarction . .... . .... 138

G. A. Ferug/io Sudden Death in Patients with Asymptomatic Coronary Heart Disease 144

D. S. Siscovick Vigorous Exercise and the Risk of Primary Cardiac Arrest ... . . . .... 151

J. Erikssen, and E. Thaulow Follow-up of Patients with Asymptomatic Myocardial Ischemia ...... 156

M . Rabaeus, A . Righetti, and P. Moret Long-term Follow-up of Patients With Positive Exercise Test Without Angina in a Referred Population . ......... . ... . .... . ........... 165

XVI

L. Samek, P. Betz, and H. Roskamm ST-Segment Depression During Exercise Without Angina Pectoris in Postinfarction Patients: Angiographic Findings and Prognostic Relevance ................................................. 170

P. F. Cohn, E. J. Brown, Jr., and J. K. Cohn Recommendations for Medical Treatment of Asymptomatic Coronary Artery Disease .............................................. 176

G. M FitzGibbon, J. R. Burton, and W. J. Keon Aortocoronary Bypass Surgery in "Asymptomatic" Patients with Coronary Artery Disease ..................................... 180

M. E. Bertrand, F. A. Thieuleux, and J. M Lablanche Proposal for a Randomized Study of Surgical Vs Medical Treatment in Patients with Asymptomatic Coronary Artery Disease .......... 194

H. Roskamm Closing Remarks ............................................ 201

Subject Index .............................................. 203

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