Circulation, Vol 81, 428-436, Copyright © 1990 by American Heart Association
JL Fleg, G Gerstenblith, AB Zonderman, LC Becker, ML Weisfeldt, PT Costa Jr and EG Lakatta
Although a silent ischemic electrocardiographic response to treadmill
exercise in clinically healthy populations is associated with an increased
likelihood of future coronary events (i.e., angina pectoris, myocardial
infarction, or cardiac death), such a response has a low predictive value
for future events because of the low prevalence of disease in asymptomatic
populations. To examine whether detection of reduced regional perfusion by
thallium scintigraphy improved the predictive value of exercise-induced ST
segment depression, we performed maximal treadmill exercise
electrocardiography (ECG) and thallium scintigraphy (201Tl) in 407
asymptomatic volunteers 40-96 years of age (mean = 60) from the Baltimore
Longitudinal Study on Aging. The prevalence of exercise-induced silent
ischemia, defined by concordant ST segment depression and a thallium
perfusion defect, increased more than sevenfold from 2% in the fifth and
sixth decades to 15% in the ninth decade. Over a mean follow-up period of
4.6 years, cardiac events developed in 9.8% of subjects and consisted of 20
cases of new angina pectoris, 13 myocardial infarctions, and seven deaths.
Events occurred in 7% of individuals with both negative 201Tl and ECG, 8%
of those with either test positive, and 48% of those in whom both tests
were positive (p less than 0.001). By proportional hazards analysis, age,
hypertension, exercise duration, and a concordant positive ECG and 201Tl
result were independent predictors of coronary events. Furthermore, those
with positive ECG and 201Tl had a 3.6-fold relative risk for subsequent
coronary events, independent of conventional risk factors.(ABSTRACT
TRUNCATED AT 250 WORDS)
ARTICLES
Prevalence and prognostic significance of exercise-induced silent myocardial ischemia detected by thallium scintigraphy and electrocardiography in asymptomatic volunteers
Gerontology Research Center, National Institute on Aging, Johns Hopkins Medical Institutions, Baltimore, MD 21224.
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