Insights From the NHLBI-Sponsored Women’s Ischemia Syndrome Evaluation (WISE) Study

Shaw, Leslee J.; Merz, C. Noel Bairey; Pepine, Carl J.; Reis, Steven E.; Bittner, Vera; Kelsey, Sheryl F.; Olson, Marian B.; Johnson, B. Delia; Mankad, Sunil; Sharaf, Barry L.; Rogers, William J.; Wessel, Timothy R.; Arant, Christopher B.; Pohost, Gerald M.; Lerman, Amir; Quyyumi, Arshed A.; Sopko, George; Investigators, Wise

doi:10.1016/j.jacc.2005.01.072

Cited by 623 publications

(214 citation statements)

References 186 publications

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“…However, experimental and clinical findings provide evidence of fundamental disparities between the sexes that in the cardiovascular system range from coronary vessel size through to intrinsic sensitivity to ischemia. Moreover, the etiology of myocardial ischemia may differ in females vs. males (147,191). Thus sex-dependent approaches may be required for effective treatment of ischemic heart disease.…”

Section: Sex Dependence Of Conventional Protectionmentioning

confidence: 99%

“…A majority of evidence supports greater tolerance to ischemic insult in female animal models (10, 21, 62, 168, 220, 228 -230) and in humans (191). None- theless, sex dependence of ischemic tolerance is still debated, as a number of other studies (148,149,193) failed to detect differences in intrinsic sensitivity to I/R.…”

Section: Sex Dependence Of Conventional Protectionmentioning

confidence: 99%

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Clinical cardioprotection and the value of conditioning responses

Peart

Headrick²

2009

American Journal of Physiology-Heart and Circulatory Physiology

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Adjunctive cardioprotective strategies for ameliorating the reversible and irreversible injuries with ischemia-reperfusion (I/R) are highly desirable. However, after decades of research, the promise of clinical cardioprotection from I/R injury remains poorly realized. This may arise from the challenges of trialing and effectively translating experimental findings from laboratory models to patients. One can additionally consider whether features of the more heavily focused upon candidates could limit or preclude therapeutic utility and thus whether we might shift attention to alternate strategies. The phenomena of preconditioning and postconditioning have proven fertile in identification of experimental means of cardioprotection and are the most intensely interrogated responses in the field. However, there is evidence these processes, which share common molecular signaling elements and end effectors, may be poor choices for clinical exploitation. This includes evidence of age dependence, limiting efficacy in target aged or senescent hearts; refractoriness to conditioning stimuli in diseased myocardium; interference from a variety of relevant pharmaceuticals; inadvertent induction of these responses by prior ischemia or commonly used drugs, precluding further benefit; and sex dependence of protective signaling. This review focuses on these features, raising questions about current research strategies, and the suitability of these widely studied phenomena as rational candidates for clinical translation.

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Section: Sex Dependence Of Conventional Protectionmentioning

confidence: 99%

Section: Sex Dependence Of Conventional Protectionmentioning

confidence: 99%

Clinical cardioprotection and the value of conditioning responses

Peart

Headrick²

2009

American Journal of Physiology-Heart and Circulatory Physiology

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“…8 As more data emerge on noninvasive testing in patients with stable angina, it is critical to keep in mind that men and women experience CAD differently, with varying symptoms, underlying pathologies, and outcomes. 5 As such, it is incumbent on researchers in this field to prespecify and adequately power their studies for sex-specific analyses, just as it is incumbent on all of us, as clinicians and consumers of this research, to be inquisitive about how diagnostic strategies might differ in women and men. Lubbers et al should be commended for conducting a rigorous sex-specific analysis of the CRESCENT trial and for filling in pieces to the puzzle that is CAD diagnosis in women and men.…”

Section: Pagidipati and Douglasmentioning

confidence: 99%

The Puzzle of Noninvasive Testing in Women

Pagidipati

Douglas

2017

Circ: Cardiovascular Imaging

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“…109,110 The diagnostic and prognostic accuracy of exercise testing in women can be improved by incorporating parameters such as exercise capacity, chronotropic response, HRR, blood pressure response, and the DTS, in addition to ST-segment depression with exercise (Table 3). 111 A negative stress ECG has a high NPV, which in combination with its low cost and wide availability make it the recommended first step in the evaluation of a symptomatic woman with chest pain.…”

Section: Kohli and Gulati Exercise Testing In Womenmentioning

confidence: 99%

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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Insights From the NHLBI-Sponsored Women’s Ischemia Syndrome Evaluation (WISE) Study

Cited by 623 publications

References 186 publications

Clinical cardioprotection and the value of conditioning responses

Clinical cardioprotection and the value of conditioning responses

The Puzzle of Noninvasive Testing in Women

Exercise Stress Testing in Women

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