Open AccessPainless myocardial ischemia in elderly patients compared with middle‐aged patients and its relation to treadmill testing and coronary hemodynamics
Author(s) -
Kurita Akira,
Takase Bonpei,
Uehata Akimi,
Maruyama Toshiharu,
Nishioka Toshihiko,
Sugahara Hiroko,
Mizuno Kyoichi,
Isojima Kazushige,
Satomura Kimio
Publication year - 1991
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960141106
Subject(s) - medicine , cardiology , hemodynamics , ejection fraction , coronary artery disease , st depression , depression (economics) , ischemia , treadmill , anaerobic exercise , artery , myocardial infarction , st segment , heart failure , physical therapy , economics , macroeconomics
We compared painless ST‐segment depression (1 mm ≥ 80 ms and lasting ≥ 60 s) in elderly patients with coronary artery disease (≥ 65 years, mean 67 years; n = 22) and that of middle‐aged patients (<60 years, mean 54 years; n = 20) by Holter monitoring for 24 hours to determine the relationship between episodes of painless myocardial ischemia, findings of treadmill testing, and coronary hemodynamics. Coronary arteriographic findings (Gensini score) and ejection fraction (EF) did not differ between the two groups. Painless ST‐segment depression was found to be 77% in the older age group versus 45% in the middle‐aged group (p<0.05). However, treadmill exercise score, ST‐segment depression, and ST‐segment integral achieved did not differ significantly between the two groups. Within 2 weeks after the above testing, coronary hemodynamic study was performed. The increment of coronary sinus flow in the older age group was 1.4±0.3 versus 1.8±0.3 in the middle‐aged group (p<0.05), and the change of lactate extraction ratio from the basal condition in the older age group was −50±40% versus −2±15% in the middle‐aged group (p<0.05). We conclude that episodes of painless myocardial ischemia in elderly patients with aging may be associated with the impairment of the coronary vascular reserve and easier anaerobic myocardial metabolism by pacing stress despite similar findings of coronary artery disease and EF in both groups.