COMPARISON OF EXERCISE-ECG AND HOLTER MON ITORING FOR THE DETECTION OF MYOCARDIAL-ISCHEMIA IN PATIENTS WITH CORONARY-ARTERY DISEASE

Holter-monitoring and exercise-ECG can be employed for the detection o f myocardial ischemia. Exercise-ECG is capable of detecting ischemias caused by physical activity. In contrast, Hotter monitoring can detect episodes of myocardial ischemia independent of exertion, but possibly connected with other factors such as mental stress. In 60 patients (4 9 male, 11 female, mean age 55.1 years) with angiographically document ed coronary artery disease (26x 1-vessel, 21x 2-vessel, 13x 3-vessel d iseases) exercise-ECG and ambulatory 24-h monitoring were performed (3 -channel recordings, ST-segment analysis). The assessment of the exerc ise-ECG showed 31 out of 60 patients with pathological results. 34 pat ients had pathological ST-segment changes during Holter monitoring (56 %). Since both methods detected different patients, a combination of these techniques is useful. The combination of Hotter monitoring and e xercise-ECG raised the sensitivity to 78 % (47/60 patients). Different heart rates were found at the point of maximal ST-segment changes in exercise-ECG as compared to the episodes of ST-segment changes recorde d by Holter monitoring. This finding clearly illustrates the fact that different pathophysiological mechanisms are causing myocardial ischem ia in respective cases.Using the coronary arteriogram as standard, the sensitivity of the two methods was different. While both techniques c ould detect multi-vessel disease at a similar level, Hotter monitoring was significantly more sensitive in detecting patients with single-ve ssel disease. Thus, exercise-ECG and Holter monitoring supplement each other in detecting myocardial ischemia. In the future, larger clinica l trials will have to confirm these results.