THE ROLE OF HOLTER ECG MONITORING IN THE DIAGNOSISOF THE PHENOMENON OF ISCHEMIC PRECONDITIONING ANDEVALUATION OF EFFECTIVENESS ANTIANGINAL THERAPY. REVIEW

Abstract

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.