Efficacy of anti-anginal drugs in the treatment of angina pectoris associated with silent myocardial ischemia: importance of quantitative Holter ECG data for patient activity.

Methods: We evaluated the clinical efficacy of transdermal nitroglycerin (NTG-TTS), a patch application of a nitrate, in the treatment of 27 patients with angina pectoris who had asymptomatic myocardial ischemic (SMI) attacks, using a double-blind cross-over method. Evaluation was made using Holter ECG and patient activity data.

Results: In frequency and duration of continuation of SMI episodes, no significant differences were noted between the observation and placebo treatment periods, while the values of both these parameters were decreased significantly in the active drug treatment period compared with those in the observation and placebo treatment periods.

The effects of an angiotensin-converting inhibitor (enalapril) on patients with mild cardiac failure--evaluating cardiac function based on the relationship between daily walking pace and heart rate.

Background: Heart failure has been evaluated by several methods, the New York Heart Association (NYHA) classification of heart failure based on symptoms being used most frequently. However, the degree of heart failure assessed by these criteria does not always correlate with cardiac function in daily life.

Hypothesis: The aim of the study was to evaluate cardiac function based on the walking pace/heart rate (HR) relationship to assess the effects of enalapril, an angiotensin-converting enzyme inhibitor, in patients with mild to moderate cardiac function.

Diagnosis of silent myocardial ischemia using ambulatory electrocardiographic monitoring with pedometer, analysis of heart rate, and ST loop in ambulatory electrocardiogram.

Background: It has been suggested that episodes of silent myocardial ischemia (SMI) might influence the prognosis of patients with ischemic heart disease, as its consequences are similar to those of myocardial ischemia accompanied by pain. Ambulatory electrocardiogram (ECG) is generally employed in diagnosis as well as in evaluation of clinical efficacy in patients with SMI, but problems related to its application remain because of the difficulty in differentiating between nonischemic and ischemic ST-segment depressions and because of the absence of data concerning body movement.

Methods And Results: We developed a method for simultaneously recording onto magnetic tape both the ECG chart and pedometer count, as well as a program which enables semi-automatic analysis of the heart rate (HR)-ST relationship.