Correlation of ST-segment depression during ambulatory electrocardiographic monitoring with myocardial perfusion and left ventricular function

To assess the relation between silent ischemia and objective markers of ischemia we compared ambulatory electrocardiographic (AECG) monitoring, exercise stress testing, and technetium-99m methoxyisobutyl isonitrile single-photon emission computed tomography (SPECT) in 68 patients with coronary artery disease. ST-segment depression at AECG monitoring occurred in 40%, exercise testing was positive in 88%, and SPECT was abnormal in 98% of patients. Patients with ST-segment depression had a higher incidence of 3-vessel disease (70% vs 45%, p = 0.04), shorter duration of exercise (267 ± 109 vs 416 ± 167 seconds, p <0.01), lower workload achieved (5.1 ± 1.9 vs 7.6 ± 2.8 METs, p <0.0002), and a greater extent of ischemia at scintigraphy (p = 0.01). Patients with a total ischemic time of >30 minutes in a 24-hour period had a lower ejection fraction (48 ± 21% vs 70 ± 9%, p = 0.001), a higher perfusion index at rest (2.4 ± 0.6 vs 1.6 ± 0.6, p = 0.001), and a greater number of segments with fixed perfusion defects (4.1 ± 3.7 vs 1.3 ± 1.8, p = 0.02) in comparison with those who had a shorter ischemic time. We conclude that AECG monitoring fails to identify a substantial proportion of patients with objective markers of ischemia; however, ST-segment depression reflects more significant disease. Longer total ischemic time correlates with the area of myocardial damage but not with other markers of ischemia.