THE ROLE OF HOLTER ECG MONITORING IN THE DIAGNOSIS OF THE PHENOMENON OF ISCHEMIC PRECONDITIONING AND EVALUATION OF EFFECTIVENESS ANTIANGINAL THERAPY. REVIEW
Introduction: Holter monitoring (HM) is used not only to detect rhythm and conduction disturbances of the heart, but also to assess episodes of myocardial ischemia in patients with coronary artery disease (IHD). At present, there is no consensus among researchers even on the issue of the diagnostic value of HM. A number of authors, revealing the high sensitivity and specificity of the method, consider; it is one of the main methods in confirming the diagnosis of coronary artery disease and evaluation of the IP phenomenon.
Objective: To analyze the literature sources on the current state of issue of the role of ECG Holter monitoring in the diagnosis and phenomenon of ischemic preconditioning and evaluating the effectiveness of antianginal therapy in patients with stable angina pectoris.
Search strategy: research publications were searched in databases of evidence-based medicine (PubMed, Scopus, Ebscohost, Medline, The Cochrane Library, SpringerLink, Web of Knowledge (Thomson Reuters), ResearchGate and electronic scientific library (CyberLeninka). Inclusion criteria were: reports about randomized and cohort studies conducted on large populations, meta-analyses and systematic reviews, original studies in English and Russian, search depth 20 years (2001-2021).
Results: HM makes it possible to identify episodes of ischemia, either caused by an increase in myocardial oxygen demand with an increase in heart rate, or dependent on a violation of coronary circulation without an increase in heart rate, or both at the same time. Exercise testing assesses the increase in oxygen demand only when the heart rate increases. For the first time ECG Holter monitoring for the study of ischemic preconditioning (IP) was carried out by D.Tzivoni, S. Maybaum, N. Bloch, M. Ilan. The time dependence of the IP phenomenon has been shown in experimental and clinical studies as protection of the myocardium due to IP. Currently, Holter monitoring is used not only to clarify the diagnosis of coronary heart disease, but also to control the treatment of patients with coronary artery disease, allowing you to get objective information about how much the episodes of myocardial ischemia in the patient's normal life have decreased under the influence of the prescribed therapy. To assess the dynamics of the disease, not only the characteristics of individual episodes of ischemia (number, duration, severity of ECG changes) are usually used, but also integral indicators, the most commonly used of which is the "total duration of ischemia per day", which is the sum of the duration of all episodes. Selection of antianginal therapy is possible with the help of HM ECG.
Conclusions: The HM method allows diagnosing the IP phenomenon. The presence of the phenomenon of adaptive protection significantly affects the level of coronary reserve and is characterized by a decrease in the duration of ischemia episodes, the total ischemia index, and an increase in exercise tolerance. Multi-day HM provides the possibility of effective selection of antianginal therapy in patients with stable angina pectoris with the PV phenomenon.
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Chinybaeva A.A. The role of Holter ECG monitoring in the diagnosis of the phenomenon of ischemic preconditioning and evaluation of effectiveness antianginal therapy. Review // Nauka i Zdravookhranenie [Science & Healthcare]. 2022, (Vol.24) 1, pp. 108-116. doi 10.34689/SH.2022.24.1.013Related publications:
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