Determinants of physical performance at cycloergometer in healthy middle aged men in Italy. The ECCIS project. Epidemiology and Clinics of Silent Ischemic Heart Disease.

OBJECTIVE: The purpose of this analysis is to relate the performance at cycloergometer of healthy middle aged men, identified in a population, with a number of personal characteristics to explain part of their physical fitness indicators. SETTING AND PARTICIPANTS: A sample of 5,163 men aged 40-59, belonging to sedentary occupational groups in Florence and Rome, were screened by a complex diagnostic procedure (participation rate = 66.3%). 3,893 were judged "healthy" from the cardiovascular point of view. MEASURES: A cycloergometric test and the measurement of some individual characteristics allowed to correlate indicators of performance at exercise (work load, test duration, work load/heart rate, PWC150 and PWC150/kg) with body mass index, resting pulse rate, systolic, diastolic and mean blood pressure. HDL and non-HDL cholesterol, a score of physical exercise and cigarette consumption. RESULTS: Univariate and multivariate analysis showed significant relationship of exercise performance indicators with age, resting pulse rate, blood pressure, cigarette consumption (inverse) and with physical exercise score (direct). These individual characteristics could explain 14-15% of the variance of exercise performance indicators. CONCLUSIONS: The analysis could not establish how much the individual characteristics were causes or effects of individual physical fitness. A reasonable cause effect relationship can be argued for physical exercise score and likely for cigarette smoking. Relatively large differences in performance indicators can be expected for people with largely different individual characteristics.

Normal behaviour of circulatory parameters during exercise. Reference values for heart rate and systemic blood pressure. The ECCIS Project data. Epidemiologia e Clinica della Cardiopatia Ischemica Silente.

The study of simultaneous variations in heart rate (HR) and systemic blood pressure is of great interest in ergometric practice complementing the analysis of the ST segment by ECG. This paper examines data proceeding from 500 consecutive, normal, exercise stress tests with the aim of offering reference values on the step-by-step behaviour of HR, systolic and diastolic blood pressure (SBP, DBP) during exercise in a normal population. The sample comes from a large epidemiological study (ECCIS Project) conducted on 4842 healthy, working men, aged 40-59, which proposes to identify, by a 3 stage procedure, subjects with totally asymptomatic coronary artery disease (type I silent ischemia). A further aim of our paper is to examine the influence of some physiological variables (age, height, weight, body mass index, resting HR, SBP and DBP) on the response to effort of HR, SBP and DBP; reciprocal HR/SBP adjustment during exercise; maximal attained workload and recovery time. Due to a preliminary observation that the rate of step-by-step increase in HR and SBP is inversely related to total duration, the population was split into 4 groups according to exercise tolerance (defined by maximal attained workload) to elaborate reference values. Furthermore our data demonstrate that: 1) SBP increases more rapidly with respect to HR for older and heavier subjects; 2) Exercise tolerance is inversely related to age, baseline HR and SBP, and directly related to weight and height; 3) return to baseline conditions, during recovery, is quicker for subjects with better exercise tolerance and lower baseline HR, SBP and weight.

[The ECCIS study: the epidemiology and clinical picture of silent ischemic cardiopathy. Epidemiologia e Clinica della Cardiopatia Ischemica Silente]. / Lo studio ECCIS: epidemiologia e clinica della cardiopatia ischemica silente.

BACKGROUND: The ECCIS project (Epidemiology and Clinic of Silent Ischemic Heart Disease) is an italian epidemiological study based on a population sample of 4,842 totally asymptomatic men aged 40-59 whose primary aim is the evaluation of the prevalence of totally silent myocardial ischemia and silent myocardial infarction. METHODS: The systemic search for markers of silent ischemia and infarction was pursued along 3 screening stages: the 1st stage included resting electrocardiogram, hyperventilation test, exercise electrocardiogram and 24-hour Holter electrocardiogram; the 2nd stage included echocardiogram, thallium-201 scintigraphy in conjunction with exercise test or dypiridamole test, exercise radionuclide ventriculography and ergometrine test; the 3rd stage included coronary angiography. After the completion of the 1st stage procedures 439 men (9.1%) with abnormal results and low probability of disease were invited to the 2nd stage and 387 accepted to undergo the diagnostic procedures. After the completion of the 2nd stage, 104 men with moderate or high suspicion of silent myocardial ischemia or infarction were invited to perform coronary angiography but only 62 men accepted to undergo the 3rd stage procedures (participation rate 59.6%). RESULTS: The final diagnosis of totally silent myocardial ischemia or infarction on the basis of predefined criteria was established in 25 patients. The prevalence of silent ischemic heart disease on the overall original 4,842 men was 0.52% (95% CL, 0.32 and 0.72%), while the final estimate after adjusting for participation rates at 2nd and 3rd stages was 0.89% (95% CL, 0.6 and 1.1%). CONCLUSIONS: The results of the ECCIS study show that the prevalence of silent myocardial ischemia is definitely lower than that revealed by prior epidemiological studies in Norway and in USA.

Coronary risk factors and silent ischemic heart disease. The ECCIS Project.

An epidemiological study was conducted on 5163 men aged 40-59 years, made by occupational samples, from Florence and Rome to identify, by a three-stage procedure, subjects with asymptomatic silent ischemic heart disease (SIHD). This report describes some coronary risk factors. Men who are free from heart disease were compared with: (1) those having a low probability of SIHD (ECG signs only; n = 439); (2) those having a high probability of SIHD (ECG signs plus echographic signs, or positive markers of deficient perfusion, or altered radionuclide ventriculography; n = 104); (3) those having a definite SIHD (signs of the first two groups plus evidence from coronary angiography; n = 25). A clearcut increasing trend in the levels of major coronary risk factors, and in the multivariate estimated coronary risk for major events was found. The difference was not significant between highly probabile and definite cases of SIHD, due to the small numbers involved. Three multiple logistic models, with the three probability levels of silent ischemia as end-points, showed that four of 10 tested factors were associated with the presence of SIHD: age, systolic blood pressure, cigarette smoking and non-HDL serum cholesterol.

Epidemiology of silent myocardial ischemia in asymptomatic middle-aged men (the ECCIS Project).

To evaluate the prevalence of type I silent myocardial ischemia and silent myocardial infarction, 4,842 men aged 40 to 59 years, identified in occupational samples in Florence and Rome, and free from major heart disease, severe illnesses and chest pain, underwent a 3-stage diagnostic procedure. The first stage included resting electrocardiogram, hyperventilation test, exercise electrocardiogram and 24-hour Holter electrocardiogram. The subjects who were suspected of having type 1 silent myocardial ischemia or previous silent infarction at the first stage (n = 439; 9.1%) were entered into the second stage, which included echocardiogram, thallium 201 scintigraphy in conjunction with exercise testing or dipyridamole test, exercise radionuclide ventriculography and ergonovine test. Three hundred eighty-seven men participated in the second stage; after the diagnostic procedures were performed, 104 men (2.1%) were still suspected of having type 1 silent myocardial ischemia or infarction on the basis of predefined criteria. Sixty-two men continued on into the third diagnostic workup including coronary angiography. The final diagnosis of type 1 silent myocardial ischemia or infarction was reached in 25 patients (prevalence 0.52%; adjusted estimate 0.89%). Of these 25, 19 had coronary atherosclerotic disease, 1 had Kawasaki disease, 1 had coronary anomaly, 1 had induced focal coronary spasm, and 2 had normal coronary arteriograms despite the presence of unquestionable old myocardial infarction. Altogether, 6 patients with silent myocardial infarction were identified.(ABSTRACT TRUNCATED AT 250 WORDS)

Spontaneous myocardial ischemia and the signal-averaged electrocardiogram.

The effects of transient myocardial ischemia on the signal-averaged electrocardiogram were investigated in 13 patients with coronary artery disease and spontaneous angina undergoing 3-channel ambulatory electrocardiography. Ischemia was seen as ST elevation in 2 patients or ST depression in 11; it was anterior in 5 patients, inferior in 4 and undefined in 4. Signal-averaged electrocardiograms with noise levels less than or equal to 1 microV were obtained from Holter tapes during 54 of 61 ischemic attacks recorded in the study group (88%), and compared with 54 tracings recorded within 60 minutes of the index attacks. Baseline tracings were normal in 8 patients (62%), showed a long QRS duration in 2 (15%), and both a long QRS duration and a late potential in the remaining 3 (23%). Comparison of recordings at baseline and during ischemic attacks revealed no significant changes in signal-averaged electrocardiographic parameters. Absence of significant differences was also noted when analysis was performed according to the type of ischemic attacks (associated with ST elevation [n = 14] or ST depression [n = 40]), their location (anterior [n = 21] or inferior [n = 23]), their duration (greater than 10 minutes [n = 29] or less than or equal to 10 minutes [n = 25]), and their magnitude (greater than 2 mm [n = 18] or less than or equal to 2 mm [n = 36]). It is concluded that spontaneous transient myocardial ischemia, independent of its type, location, duration and magnitude, does not generate a substrate for late potentials on the signal-averaged electrocardiogram.