The role of Holter ECG monitoring in the diagnosis of ischemic heart disease in women

Scope: Ischemic heart disease (IHD) is currently the leading cause of mortality in women. Frequently, women have microvascular heart disease so coronary angiography is normal. Many women have a poor physical condition being unable to reach the maximum heart rate at exercise stress test, resulting in an inconclusive test. A diagnostic test for IHD that is more appropriate for women is needed. In this study we aimed to evaluate Holter ECG monitoring as a diagnostic test for IHD in women starting from the premises proven in the literature: episodes of silent myocardial ischemia recorded on Holter ECG have the same unfavorable significance as symptomatic ones; the incidence of silent ischemia is higher among the female population

Methods: The study included 225 female patients who underwent ECG Holter recording (Cardiology Depart-ment of the Clinical Rehabilitation Hospital of Cluj-Napoca) divided into 2 groups: 136 previously diagnosed with IHD (IHD+) and 89 without diagnosis of IHD (IHD-). The Holter ECG recordings were assessed for the presence of episodes of myocardial ischemia (ST segment elevation greater than 5 mm), duration and ischemic load (the percentage that episodes of myocardial ischemia accounted throughout the recording). The results obtained were statistically processed using Microsoft Excel 2010 and Epiinfo 3.5.1. The threshold value of the chosen statistical significance was p <0.05.

Results: Mean age of the patients included in the study was 62.31 ± 12.51 years. The two groups were similar regarding associated risk factors (hypertension, obe-sity, dyslipidemia, diabetes mellitus), echocardiographic parameters (left ventricular size, ejection fraction, kinetic disorders), minimum and maximum heart rates registered on Holter ECG. Statistically significant diffe-rences were identified in: presence of atrial fibrillation episodes (21.3% in IHD+ vs 8.9% in IHD-), presence of episodes of myocardial ischemia (55.14% in IHD+ vs 42.69% In IHD-), ischemic load (15.23 ± 30.54% in IHD+ vs 4.7 ± 15.65% in IHD-), duration of ischemia (174.16 ± 380.75 minutes in IHD+ vs 59.44 ± 209.02 minutes in IHD-).

Conclusions: Although episodes of myocardial ischemia were also present in IHD-, our study demonstrated that the diagnosis of IHD can be established by Hol-ter ECG using the threshold values of ischemic load (> 15%) and total ischemic duration (> 174 minutes). The use of Holter ECG recording increases the chance of detecting myocardial ischemia and is effective in establishing the diagnosis of IHD in women, an important aspect because globally, women are underdiagnosed and undertreated due to classical diagnostic methods that have a low efficiency in female population.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)