Clinical validation of four solid state ambulatory monitoring devices in detecting shift of the ST segment

Introduction: Cholesterol lowering is associated with a reduction in cardiovascular morbidity and mortality. Statins are the main drugs for cholesterol lowering. Ezetimibe when added to statins gives further reduction in cholesterol but its long-term effect on cardiovascular morbidity and mortality and ischemic events is not known. This study sought to determine whether further cholesterol lowering with ezitimibe will also results in a reduction of myocardial ischemia during daily life. Hypothesis: Further cholestrol with ezetimibe lowering may reduce silent ischemia. Methods: We enrolled 50 patients with proven stable coronary artery disease (CAD) and at least one episode of ST-segment depression on ambulatory ECG monitoring. All of them were receiving optimal therapy for CAD including statin therapy for cholesterol reduction. 25 patients were randomized to continue their statin therapy (Statin only group) and 25 to recieve statin plus Ezitimibe 10mg/day (ezitimibe group). Serum cholesterol and LDL cholesterol levels and ambulatory monitoring were repeated after 4 to 6 months of therapy. The two groups were comparable with respect to baseline characteristics, number of episodes of ST-segment depression, and baseline serum cholesterol levels. Holters were read by a blinded cardiologist. Results: The ezitimibe group had lower mean total and LDL cholesterol levels at study end and experienced a significant reduction in the number of episodes of ST-segment depression compared with the statin only group. ST-segment depression was completely resolved in 13 of 25 patients (52%) in the ezitimibe group versus 3 of 25 (12%) in the statin only group. The ezitimibe group exhibited a highly significant reduction in ambulatory ischemia (P<.001). By logistic regression, treatment with ezitimibe was an independent predictor of ischemia resolution. Conclusions: Further cholesterol lowering with ezitimibe can result in reduction or resolution of myocardial ischemia recorded as episodes of ST-segment depression in ambulatory monitoring of the ECG. A larger study is required to confirm this results. This may be translated into long term mortality reduction for CAD by adding ezetimibe.

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ST-segment analysis with ambulatory ECG monitoring: are solid state recorders better than tape cassettes?

[1990] Proceedings Computers in Cardiology ◽

10.1109/cic.1990.144190 ◽

2002 ◽

Cited By ~ 1

Author(s):

T. Brueggemann ◽

D. Andresen ◽

R. Schroeder

Keyword(s):

Solid State ◽

Ecg Monitoring ◽

Ambulatory Ecg ◽

Ambulatory Ecg Monitoring ◽

St Segment ◽

Better Than

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Walking, but Not Weight Lifting, Acutely Reduces Systolic Blood Pressure in Older, Sedentary Men and Women

Journal of Aging and Physical Activity ◽

10.1123/japa.3.2.163 ◽

1995 ◽

Vol 3 (2) ◽

pp. 163-177 ◽

Cited By ~ 1

Author(s):

W. Jack Rejeski ◽

Karen M. Neal ◽

Martine E. Wurst ◽

Peter H. Brubaker ◽

Walter H. Ettinger

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Daily Living ◽

Statistical Significance ◽

Ambulatory Monitoring ◽

Weight Lifting ◽

Osteoarthritis Of The Knee ◽

Acute Bout ◽

Monitoring Devices ◽

Laboratory Stressor

An elderly patient population was used to investigate whether an acute bout of aerobic exercise (AE) would reduce systolic blood pressure (SBP) to a greater extent than would a bout of weight lifting (WL). SBPs were studied in the context of a laboratory Stressor as well as during activities of daily living using ambulatory monitoring devices (AMBPs). Patients participated in a laboratory Stressor and were monitored via AMBP for 8 hr. SBPs were lower for up to 5 hr postexercise for the AE treatment only. In addition, in comparison to no-exercise control data, baseline SBP was lower for the AE group than the WL group prior to the Stressor. Subjects in the AE condition also tended to have lower SBP responses following exercise than patients in the WL group, although these differences did not reach a conventional level of statistical significance. These data provide evidence that single bouts of AE, but not WL, may lower SBP in elderly patients, even for those who have compromised function due to osteoarthritis of the knee.

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