Response to Letters Regarding Article, “Comparative Effectiveness of Exercise Electrocardiography With or Without Myocardial Perfusion Single Photon Emission Computed Tomography in Women With Suspected Coronary Artery Disease: Results From the What Is the Optimal Method for Ischemia Evaluation in Women (WOMEN) Trial”

Shaw, Leslee J.; Veledar, Emir; Wenger, Nanette K.; Mieres, Jennifer H.; Hendel, Robert H.; Boden, William E.; Gulati, Martha; Hachamovitch, Rory; Arrighi, James A.; Merz, C. Noel Bairey; Gibbons, Raymond J.; Heller, Gary V.

doi:10.1161/circulationaha.112.092270

Cited by 25 publications

(39 citation statements)

References 8 publications

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“…However, the WOMEN study of 824 women randomized to exercise ECG versus exercise MPI found comparable major adverse cardiac event (MACE) rates in women with normal test results (0.4% for exercise ECG vs. 1.2% for exercise MPI) (44). These findings suggest that similar low-risk patients with good functional capacity and no known CAD should undergo exercise ECG as their initial test for ischemia.…”

Section: Figure 6 Survival In End-stage Renal Disease Stratified By mentioning

confidence: 95%

Stress Myocardial Perfusion Imaging for Assessing Prognosis: An Update

Bourque

Beller

2011

JACC: Cardiovascular Imaging

107

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A strength of nuclear myocardial perfusion imaging (MPI) is the wealth of prognostic data accumulated over 30 years of experience with this technique. Nuclear MPI can predict outcomes and guide revascularization decisions in symptomatic patients and is well validated in special populations such as patients with diabetes and chronic renal disease. Known limitations, such as underestimation of ischemia and radiation burden, are being progressively reduced through advances such as positron emission tomography absolute flow quantification and fusion with computed tomography, new camera hardware and software, and stress-only protocols. Advanced statistical techniques and increasing focus on comparative effectiveness and appropriateness will continue to optimize nuclear cardiology going forward.

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Section: Figure 6 Survival In End-stage Renal Disease Stratified By mentioning

confidence: 95%

Stress Myocardial Perfusion Imaging for Assessing Prognosis: An Update

Bourque

Beller

2011

JACC: Cardiovascular Imaging

107

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“…Only 7.4% of patients had abnormal MPI findings, and there were no myocardial infarctions or cardiac deaths over 3 years of follow-up in any patients, including those with known CAD. Similarly, a larger study by Shaw et al 125 found that MPI may not add much clinical utility to ECG results in women able to exercise. In a study of 824 women in the multicenter "What is the Optimal Method for Ischemia Evaluation in Women?"…”

Section: Mpi For Risk Stratification Of Womenmentioning

confidence: 97%

The Role of Nuclear Cardiology in the Diagnosis and Risk Stratification of Women With Ischemic Heart Disease

Esteves

Travin

2014

Seminars in Nuclear Medicine

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“…This concept of an ECG-first strategy is supported by the results of a recent randomised clinical trial and is further detailed in the recent AHA consensus statement (figure 1). 2 3…”

Section: Optimising Low-cost Technologymentioning

confidence: 99%

“…Important considerations for the exercise ECG are the abundant evidence on prognostication and diagnostic accuracy in women and its comparative effectiveness compared with other modalities such as nuclear imaging 2. In this review, we will highlight the major dilemmas in interpreting suspected CAD symptoms in women and identify optimal strategies for employing exercise ECG as a first-line diagnostic test in the SIHD evaluation algorithm.…”

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confidence: 99%

Optimising diagnostic accuracy with the exercise ECG: opportunities for women and men with stable ischaemic heart disease

Shaw

Xie

Phillips³

et al. 2016

Heart Asia

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The exercise ECG is an integral part within the evaluation algorithm for diagnosis and risk stratification of patients with stable ischaemic heart disease (SIHD). There is evidence, both older and new, that the exercise ECG can be an effective and cost-efficient option for patients capable of performing at maximal levels of exercise with suitable resting ECG findings. In this review, we will highlight the major dilemmas in interpreting suspected coronary artery disease symptoms in women and identify optimal strategies for employing exercise ECG as a first-line diagnostic test in the SIHD evaluation algorithm. We will highlight current evidence as well as recent guideline statements on this subject. Trial registration number NCT01471522; Pre-results.In today's practice of cardiovascular medicine, diverse technology is available to aid diagnosis and risk stratification of patients with stable ischaemic heart disease (SIHD) that include those with suspected and known obstructive coronary artery disease (CAD). These patients represent the core of eligible patients who may be referred for a diagnostic evaluation using exercise ECG or a CAD noninvasive imaging modality.1 Although for many physicians there is a perception that all patients require some form of imaging to diagnose CAD, there is evidence, both old and new, that the exercise ECG can be effective and cost-efficient for patients capable of performing at maximal levels of exercise with suitable resting ECG findings. 2Our focus on the diagnostic evaluation of women with SIHD is important as there are common misperceptions that the exercise ECG is inaccurate in women and that alternative approaches should be employed to a greater extent, including non-invasive imaging and invasive coronary angiography. Important considerations for the exercise ECG are the abundant evidence on prognostication and diagnostic accuracy in women and its comparative effectiveness compared with other modalities such as nuclear imaging.2 In this review, we will highlight the major dilemmas in interpreting suspected CAD symptoms in women and identify optimal strategies for employing exercise ECG as a first-line diagnostic test in the SIHD evaluation algorithm. We will highlight current evidence as well as a recent expert consensus statement from the American Heart Association (AHA) on this subject.3

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Cited by 25 publications

References 8 publications

Stress Myocardial Perfusion Imaging for Assessing Prognosis: An Update

Stress Myocardial Perfusion Imaging for Assessing Prognosis: An Update

The Role of Nuclear Cardiology in the Diagnosis and Risk Stratification of Women With Ischemic Heart Disease

Optimising diagnostic accuracy with the exercise ECG: opportunities for women and men with stable ischaemic heart disease

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