Extent and severity of abnormal left ventricular wall motion detected by exercise echocardiography during painful and silent ischemia

Myocardial ischemia occurs in the absence of symptoms in a proportion of patients with coronary artery disease, a phenomenon that may reflect disturbed pain responsiveness.1 Episodes of painless (“silent”) ischemia are frequent even in patients who have angina at other times,2 suggesting that some features of the ischemic event, rather than the patient, may be responsible for the absence of pain. One possible explanation is that the occurrence of pain relates to the extent or severity of ischemia. The relation of angina to the amount of left ventricular dysfunction has been debated, with evidence in favor3 and against4,5 a positive correlation. This study compared the severity and extent of ischemia, assessed by exercise echocardiography, with the presence of angina.