Diagnostic accuracy of exercise ECG lead systems in clinical subsets of women.

Abstract

The diagnostic accuracy of 14-lead exercise electrocardiography was evaluated in 112 women who had no history of myocardial infarction and underwent coronary angiography. The sensitivity of ST-segment displacement of 0.1 mV or more in any of 14 ECG leads was 0.79 for coronary artery stenosis of at least 70%; the specificity was 0.66. Results were similar using bipolar ECG leads CC5 and CM5 or 11 standard ECG leads. The ST-segment shifts that occurred only during exercise were associated with a 77% false-positive rate (10 of 13). Downsloping ST-segment depression did not provide more diagnostic information than horizontal ST-segment depression in the three clinical subsets of women. In women with typical angina pectoris, ST-segment depression of at least 0.15 mV for 0.08 second after the J point or a final treadmill time less than 360 seconds was predictive of proximal left or multivessel coronary artery disease. In the women with probable angina or nonspecific chest pain, this finding was not of diagnostic value. ST-segment elevation of 0.1 mV or more in leads V1-2 or a VL predicted proximal stenosis of at lest 80% in the left anterior descending coronary artery in all six women with typical angina pectoris. Maximal exercise testing in women with typical angina provides important diagnostic information when 11 standard ECG leads are recorded. In women with probable angina or nonspecific chest pain, diagnostic exercise testing is less useful and bipolar leads CC5 and CM5 are sufficient for most clinical purposes.

New parameters in the interpretation of exercise testing in women: QTC dispersion and QT dispersion ratio difference

“…18 The false-positive rate in women depends on disease prevalence and ranges from 25% in patients with typical angina to 50% in patients with atypical chest pain. 19 Several mechanisms have been suggested to explain the high false-positive rate of ST-segment depression in women, including the fact that estrogen has a chemical structure similar to digitalis. It has been suggested that this may be partially responsible for the high prevalence of false-positive test results in women.…”

Exercise and Lipid Abnormalities

“…Segmental ST depression occurred during exercise in 8 of 29 boys with ''monogenic'' familial hyperlipoproteinemia compared to 4 of 55 normal boys (p < 0.05) and in 6 of 32 hypercholesterolemic girls compared to 7 of 48 normal girls (p > 0.05). As the authors indicate, the clinical importance of these findings is not clear in light of the known occurrence of false positives in adults and the higher prevalence of false positives in adult females [16]. They report that the findings were reproducible on follow-up exercise testing in both the hyperlipidemic and normal children.…”

The care of patients with ischaemic heart disease from a gender perspective

“…What has been established is that women with typical symptoms of angina and obvious changes in their ECG at rest and after exercise tests do not display atherosclerotic changes in the coronary arteries to the same extent as men, at least not in the epicardial vessels which appear in coronary angiography [33,34] .…”

“…Studies [33][34][35][36][37] have shown that women with typical angina have a high prevalence of coronary artery disease, whereas the prevalence among those with atypical symptoms was low. Once again, however, age is significant, as pre-menopausal women with typical angina manifest a prevalence of 50% as opposed to 90% in older women with the same symptoms.…”