The Value of Systolic Time Intervals as Prognostic Indicators in Coronary Artery Disease
As evidenced in this quotation from Hippocrates’ treatise on Prognostics, interest in predicting the course of disease dates from the very beginnings of scientific medicine. With respect to coronary artery disease, the dire prognosis of patients with angina pectoris was uncovered by the very physician who described the symptom, William Heberden. In 1772 he wrote: “The termination of the angina pectoris is remarkable. For if no accident intervene, but the disease go on to its height, the patients all suddenly fall down, and perish almost immediately.”. It was not until the 19th century, however, when quantitative methods for expressing mortality in large populations of patients emerged, that the earliest scientific studies on the prognosis of patients with varying signs and symptoms of coronary artery disease were published. It is notable, in this regard, that the first actuarial study of angina pectoris was reported by Herrick and Nazum only a few years after Herrick had described the clinical picture of sudden obstruction of the coronary arteries. These studies, followed by those of Richards, Bland, and White and Block and co-workers, established that among patients with angina pectoris a poor prognosis was associated with the presence of cardiac enlargement, hypertension, an abnormal electrocardiogram, a past history of myocardial infarction and the presence of clinically evident congestive heart failure. The more recent Framingham study confirmed the poor prognosis of patients with manifest clinical heart failure after myocardial infarction.
KeywordsCoronary Artery Disease Sudden Death Angina Pectoris Left Ventricular Dysfunction Previous Myocardial Infarction
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