Differences in electrocardiographic response to exercise of women and men: a non-Bayesian factor.

Barolsky, Stephen M.; Gilbert, Charles A.; Faruqui, Azhar; Nutter, Donald O.; Schlant, Robert C.

doi:10.1161/01.cir.60.5.1021

Cited by 155 publications

(34 citation statements)

References 13 publications

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“…Low sensitivity of ST-segment depression in V 4 -V 6 has been described before [19,20]. ST-segment deviations were found to have limited predictive value in CAD in women [21,22].…”

Section: Discussionmentioning

confidence: 61%

Increased sensitivity of prolonged P-wave during exercise stress test in detection of angiographically documented coronary artery disease

Wsol

Wydra²,

Chmielewski³

et al. 2017

Cardiol J.

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CAD was 69% and 47%, respectively, respectively. The presence of arterial hypertension negatively influenced the prognostic value of P-wave changes in the stress test. Conclusions: The results of the study show that an addition of P-wave duration changes assessment to ST-depression analysis and other exercise-induced abnormalities increase sensitivity of EST, especiallyfor left CAD and 3-vessel coronary disease. We have also provided evidence for the negative influence of the presence of arterial hypertension on the predictive value of P-wave changes in the stress test. (Cardiol J 2017; 24, 2: 159-166)

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“…Low sensitivity of ST-segment depression in V 4 -V 6 has been described before [19,20]. ST-segment deviations were found to have limited predictive value in CAD in women [21,22].…”

Section: Discussionmentioning

confidence: 61%

Increased sensitivity of prolonged P-wave during exercise stress test in detection of angiographically documented coronary artery disease

Wsol

Wydra²,

Chmielewski³

et al. 2017

Cardiol J.

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“…34 In a study of symptomatic men and women undergoing exercise ECG and subsequent angiography, the positive predictive value of ST-segment depression with exercise testing in women was significantly lower than in men (47% versus 77%, respectively; PϽ0.05). 35 However, the negative predictive value (NPV) of ST-segment depression in symptomatic women was similar to that of men (78% versus 81%, respectively). Although women are more likely to have a "false-positive" exercise ECG, a negative exercise stress test is useful in effectively ruling out a diagnosis of CAD.…”

Section: Diagnostic Valuementioning

confidence: 89%

Exercise Stress Testing in Women

2010

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Marked reductions in cardiovascular mortality in women have occurred for the first time this decade as a result of advances in medical treatment, improvement in medical technology, and a greater focus on women and their cardiovascular risk. 1 Nonetheless, cardiovascular disease remains the No. 1 cause of death for women in the United States, and more women die from cardiovascular disease than men every year. 2 In addition, women with coronary artery disease (CAD) are more likely to have a poorer prognosis than men. 1,3,4 Women who have an acute myocardial infarction have a higher mortality than their male counterparts, and women who have symptoms of angina or an abnormal stress test are less likely to be referred for further diagnostic testing. 2,[5][6][7] Given these gender differences in the evaluation of possible CAD symptoms and the higher mortality due to CAD in women, critical steps should be taken to identify women at the earliest stage of presentation so that appropriate therapeutic strategies can be implemented. Nonetheless, identifying women with coronary disease can be a diagnostic challenge. The prevalence of CAD in younger women is low, and women tend to present with symptoms and CAD at older ages as compared with men. In addition, women may present with more atypical symptoms. 8 Women also have a lower prevalence of obstructive coronary disease, making diagnostic testing designed to detect focal areas of coronary stenosis less sensitive and specific in this population. 9 Currently, exercise stress testing is the most commonly used method of diagnosing CAD in women, 10 -12 Historically, exercise stress testing in women has been thought to have a decreased diagnostic accuracy because of a lower prevalence of CAD in women, but most early studies evaluating stress testing as a diagnostic tool were performed in almost exclusively male cohorts. [15][16][17][18][19][20][21][22][23][24][25] Until recently, the representation of women in published studies was too small to determine any gender differences in test accuracy. The underrepresentation of women, as well as the bias in selection of women when included, may be the reason for the misconceptions regarding the value of exercise stress testing in women. Nonetheless, research on exercise stress testing in women has increased in the past decade, improving our understanding of the diagnostic and prognostic value of this modality in women.The purpose of this article is to review the literature regarding exercise stress testing in women, with a focus beyond ST-segment depression alone. It addition to interpretation of ECG changes with exercise, evaluation of exercise capacity, chronotropic index, heart rate (HR) recovery (HRR), blood pressure response, and Duke Treadmill Score (DTS) can be used to enhance the utility of exercise testing. The diagnostic and prognostic value of these non-ECG variables in women is reviewed, with a goal of highlighting the importance of exercise stress testing in women on the basis of the research available to date. ST-Segment...

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“…Exercise ECG is generally considered also as less specific in women than in men even after correction for post-test referral bias [30]. Among the non-Bayesian factors, syndrome X, differences in microvascular function, and possibly hormonal differences have been discussed [12,31]. Current guidelines recognize the limitations in accuracy of exercise ECG and that stress-imaging approaches in general may be an efficient initial alternative in women.…”

Section: Discussionmentioning

confidence: 99%

Comparison of exercise electrocardiography and stress perfusion CMR for the detection of coronary artery disease in women

Greulich

Bruder

Parker

et al. 2012

Journal of Cardiovascular Magnetic Resonance

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BackgroundExercise electrocardiography (ECG) is frequently used in the work-up of patients with suspected coronary artery disease (CAD), however the accuracy is reduced in women. Cardiovascular magnetic resonance (CMR) stress testing can accurately diagnose CAD in women. To date, a direct comparison of CMR to ECG has not been performed.Methods and resultsWe prospectively enrolled 88 consecutive women with chest pain or other symptoms suggestive of CAD. Patients underwent a comprehensive clinical evaluation, exercise ECG, a CMR stress test including perfusion and infarct imaging, and x-ray coronary angiography (CA) within 24 hours. CAD was defined as stenosis ≥70% on quantitative analysis of CA.Exercise ECG, CMR and CA was completed in 68 females (age 66.4 ± 8.8 years, number of CAD risk factors 3.5 ± 1.4). The prevalence of CAD on CA was 29%. The Duke treadmill score (DTS) in the entire group was −3.0 ± 5.4 and was similar in those with and without CAD (−4.5 ± 5.8 and −2.4 ± 5.1; P = 0.12). Sensitivity, specificity and accuracy for CAD diagnosis was higher for CMR compared with exercise ECG (sensitivities 85% and 50%, P = 0.02, specificities 94% and 73%, P = 0.01, and accuracies 91% and 66%, P = 0.0007, respectively). Even after applying the DTS the accuracy of CMR was higher compared to exercise ECG (area under ROC curve 0.94 ± 0.03 vs 0.56 ± 0.07; P = 0.0001).ConclusionsIn women with intermediate-to-high risk for CAD who are able to exercise and have interpretable resting ECG, CMR stress perfusion imaging has higher accuracy for the detection of relevant obstruction of the epicardial coronaries when directly compared to exercise ECG.

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Differences in electrocardiographic response to exercise of women and men: a non-Bayesian factor.

Cited by 155 publications

References 13 publications

Increased sensitivity of prolonged P-wave during exercise stress test in detection of angiographically documented coronary artery disease

Increased sensitivity of prolonged P-wave during exercise stress test in detection of angiographically documented coronary artery disease

Exercise Stress Testing in Women

Comparison of exercise electrocardiography and stress perfusion CMR for the detection of coronary artery disease in women

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