Document Detail


Exercise treadmill testing using a modified exercise protocol in women with suspected myocardial ischemia: findings from the National Heart, Lung and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE).
MedLine Citation:
PMID:  15864243     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Exercise testing, a major diagnostic modality in individuals with suspected coronary artery disease (CAD), has in general demonstrated less overall diagnostic accuracy in women compared to men. As part of the WISE, a modified protocol was examined with the intention of improving reliability of exercise testing. METHODS: Criteria for entry in the WISE study include clinically indicated coronary angiography. Exercise testing was performed using a protocol modified to be more appropriate for women. The study population consisted of 96 women, mean age of 55.8 y (range 34-77), who completed exercise treadmill test (ETT). Most (78%) were postmenopausal; 96% had >or =2 risk factors for CAD. RESULTS: By core laboratory angiography, 29/96 women had stenosis > or =50% in at least one coronary artery. Of these 29 women, 9 had abnormal ETT, yielding overall sensitivity of 31%. The remaining 20 women had normal (12/29, 41%) or nondiagnostic (8/29, 28%) studies. Among the 67 women with minimal or no coronary stenosis, 35 had no ischemic ST-segment changes during ETT, yielding overall specificity of 52%. Analysis with exclusion of women with nondiagnostic studies yielded sensitivity and specificity of 43% and 66%, respectively. The presence of coronary artery stenosis and inability to perform ETT, but not results of testing, predicted the outcomes of myocardial infarction, heart failure, and death. CONCLUSIONS: Exercise treadmill test appears to be of limited diagnostic value in women with suspected myocardial ischemia referred for coronary angiography. Sensitivity and specificity remain poor even with modified exercise protocol and core laboratory angiographic analysis. These findings merit consideration in view of current guidelines that recommend exercise testing in women with suspected CAD.
Authors:
Jannet F Lewis; Susan McGorray; Lang Lin; Carl J Pepine; Bernard Chaitman; Mark Doyle; Daniel Edmundowicz; Barry L Sharaf; C Noel Bairey Merz;
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  American heart journal     Volume:  149     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2005 Mar 
Date Detail:
Created Date:  2005-05-02     Completed Date:  2005-10-31     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  527-33     Citation Subset:  AIM; IM    
Affiliation:
WISE Clinical Centers, Division of Cardiology, University of Florida, Gainesville, Fla, USA. jlewis@mfa.gwu.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Clinical Protocols
Coronary Angiography
Coronary Stenosis / complications,  diagnosis*
Electrocardiography
Exercise Test / methods*
Female
Follow-Up Studies
Humans
Middle Aged
Myocardial Ischemia / diagnosis*,  etiology
Sensitivity and Specificity
Women's Health*
Grant Support
ID/Acronym/Agency:
01HL64914/HL/NHLBI NIH HHS; M01-RR00425/RR/NCRR NIH HHS; N01-HV-681063/HV/NHLBI NIH HHS; N01-HV-681064/HV/NHLBI NIH HHS; N01-HV-68161/HV/NHLBI NIH HHS; N01-HV-68162/HV/NHLBI NIH HHS; R01 HL64829-01/HL/NHLBI NIH HHS; R01 HL64924-01/HL/NHLBI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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