Elevated arterial pressure and postexertional ST-segment depression in middle-aged women

Kusumi, Fusako; Bruce, Robert A.; Ross, Marie‐Kristelle; Trimble, Shirley; Voigt, Angelika

doi:10.1016/s0002-8703(76)80076-2

Cited by 11 publications

(3 citation statements)

References 18 publications

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“…The results of the present study, how ever, are in agreement with the reports of some clinical [2,6] and coro nary artériographie [22] studies which suggest a low diagnostic specificity of the exercise test in women. Several pathogenetic hypotheses have been advanced [15,22], but the underlying mechanism of the exercise 'isch emic' pattern in women is not clear yet. In spite of the results of Q uiret el al.…”

Section: Discussionmentioning

confidence: 99%

Different Prognostic Value of Exercise Electrocardiogram in Men and Women

Manca¹,

Dei²,

Albertini³

et al. 1978

Cardiology

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In 1,455 subjects (947 men and 508 women) who underwent a bicycle ergometer stress test for evaluation of atypical chest pain, the incidence of coronary events (definite myocardial infarction or sudden death) was assessed by the life table method. The follow-up period ranged from 3 to 7 years (mean 5.2 years). In men with positive exercise test (ischemic ST depression ≧ 1 mm), the 5-year incidence of coronary events was 18.3%, compared with 1.9% in negative responders. In women with positive response, the 5-year incidence of coronary events was 4.6%; in negative responders, it was 0.3%. The poor predictive value of ischemic ST responses to exercise in women is emphasized.

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Section: Discussionmentioning

confidence: 99%

Different Prognostic Value of Exercise Electrocardiogram in Men and Women

Manca¹,

Dei²,

Albertini³

et al. 1978

Cardiology

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“…Some data suggest that non-Bayesian factors may also play a role [18]. Women have been described as having a lower level of hemato crit [23], a higher pulmonary and systemic pressure response to exercise [24], and a higher level of circulating estrogen which has a chemical structure similar to digi talis.…”

Section: Historymentioning

confidence: 99%

Coronary Atherosclerotic Heart Disease: Some Important Differences in Men and Women

Glazer¹,

Hurst²

1987

Am J Noninvas Cardiol

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Important sex-related differences exist in almost every aspect of coronary atherosclerotic heart disease. In general, women lag some 10-20 years behind men in the incidence of angina pectoris, sudden unexpected death, and acute myocardial infarction. The history is of considerable diagnostic value in men in establishing the presence of significant coronary atherosclerotic heart disease. The value of the history in women is somewhat limited except in the subgroup over 70 years of age with definite angina pectoris. The following noninvasive tests are available to aid the clinician in establishing disease likelihood: (1) exercise electrocardiography; (2) rest and exercise myocardial perfusion imaging with thallium, and (3) rest and exercise radionuclide ventriculography. Each has specific diagnostic limitations in women. Coronary artery bypass surgery in women is associated with a slight increase in operative risk, and this may be related to body size. Percutaneous transluminal coronary angioplasty is associated with a higher initial success rate in men than in women. The long-term outlook following successful percutaneous transluminal coronary angioplasty is brighter in women than in men.

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“…Kusumi et al 12 , studying the left ventricular function of healthy women with ST segment depression compared with others with normal responses, showed that the hemodynamic stress induced by augmented intraventricular pressure was responsible for the abnormal tests.…”

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confidence: 99%

Noninvasive diagnostic evaluation for chest pain in women

Chalela¹,

Mansur²,

Aldrighi³

2001

Arq. Bras. Cardiol.

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UpdateWomen are eight times less likely to develop myocardial infarction than men are; nonetheless, when myocardial ischemic disease is present, it has a worse evolution 1,2 . No explanations for this fact are available, although speculations exist about the inadequate manner of diagnosis.It is worth emphasizing that in studies about coronary disease, women are either a minority or excluded from the study protocols. Therefore, most of the information regarding coronary disease in women comes from studies conducted in men. In fact, invasive cardiovascular procedures -either diagnostic or therapeutic -are frequently less indicated for women who bear confirmed coronary disease. However, it is not yet clearly established whether this difference is due to a larger use of such procedures in men or to a smaller indication in women.Typical angina is more prevalent in women, although angiographic studies have revealed that all forms of angina, including the typical type, are associated on a smaller scale with coronary disease in women when compared with that men. The CASS 3 study reveals that 62% of women with defined angina had ischemic disease compared with 40% of those with probable angina and 4% with nonischemic pain.We propose to critically evaluate the main noninvasive diagnostic methods for chronic coronary disease in women.Electrocardiogram -The association between electrocardiographic abnormalities at rest and a higher incidence of cardiovascular diseases is well documented in men but not in women. When ranking different levels of rest electrocardiographic abnormalities in men and women aged 40 to 64 years and with higher risk of cardiovascular disease-induced death, De Bacquer et al 4 observed higher relative risk for men. High-degree abnormalities were directly associated with mortality in both sexes, but low-degree abnormalities were not. The abnormalities considered as high degree were the presence of depression of the ST segment, T-wave inversion, complete or 2 nd degree atrioventricular block, branch (left or right) block, frequent extrasystoles and atrial fibrillation or flutter; low-degree abnormalities were a deviated QRS axis complex with high or low voltage and other alterations in ventricular repolarization. De Bacquer et al 4 demonstrated that depression of the ST segment in the rest electrocardiogram was associated with higher cardiovascular mortality, and was equally important in both sexes. The T-wave abnormalities were also more predictive for men, whereas arrythmias were more predictive for women. It is worth emphasizing that low-degree abnormalities did not have predictive values for either sex.Stress test -Several studies 3-7 have revealed a reduced amount of noninvasive diagnostic interventions for coronary disease in women. This is so because of the lower prevalence of ischemic disease in women, in addition to a higher number of false-positives 8 , ie, the specificity of the conventional effort test is lower in women, compared with that observed in men. It is important to consider the proba...

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Elevated arterial pressure and postexertional ST-segment depression in middle-aged women

Cited by 11 publications

References 18 publications

Different Prognostic Value of Exercise Electrocardiogram in Men and Women

Different Prognostic Value of Exercise Electrocardiogram in Men and Women

Coronary Atherosclerotic Heart Disease: Some Important Differences in Men and Women

Noninvasive diagnostic evaluation for chest pain in women

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