Skip to main content
SpringerLink
Log in

Exercise electrocardiogram testing and imaging in women

  • Published:
Current Cardiovascular Risk Reports Aims and scope Submit manuscript

Abstract

The increased awareness of the incidence and risk of coronary heart disease (CHD) has increased the efforts of physicians to identify women with CHD as early as possible. Exercise electrocardiogram (ECG) testing and imaging have been used in this manner for men and women but represent unique challenges with regard to women. Exercise ECG testing, which determines the presence of coronary artery disease by the provocation of ST depression and chest pain, has a lower positive predictive value in women than in men of the same age. This is explained by a lower prevalence of CHD in female patients with symptoms and (to a lesser extent) by the reported lower sensitivity and specificity of the test in women as compared with men. Exercise nuclear isotope myocardial perfusion imaging and exercise echocardiography have higher reported specificity and sensitivity, and new imaging agents, contrast echo agents, and acquisition protocols have reduced the limitations of these studies in selected women. The value of the exercise ECG examination with regard to CHD event risk assessment is equal in men and women and should be incorporated into the clinical evaluation of appropriate women patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Mieres JH, Shaw LJ, Arai A, et al.: Role of noninvasive testing in the clinical evaluation of women with suspected coronary heart disease, an AHA scientific statement. Circulation 2005, 111:682–696.

    Article  PubMed  Google Scholar 

  2. Diamond GA, Forrester JS: Analysis of probability as an aid in the clinical diagnosis of coronary artery disease. N Eng J Med 1979, 300:1350–1358.

    Article  CAS  Google Scholar 

  3. Phibrick JT, Horwotz RI, Feinstein AR: Methodologic problems of exercise testing for coronary artery disease: groups, analysis and bias. Am J Cardiol 1980, 46:807.

    Article  Google Scholar 

  4. Detrano R, Yiaannikas J, Salcedo EE, et al.: Bayesian problability analysis: a prospective demonstration of its clinical utility in diagnosing coronary artery disease. Circulation 1984, 69:541–550.

    PubMed  CAS  Google Scholar 

  5. Ellestad MH: Stress Testing Principles and Practice, edn 4. FA Davis Co., Philadlphia, 1986.

    Google Scholar 

  6. Scherlis L, Sandberg AA, Wener J, et al.: Effects of single and double two step exercise tests upon the electrocardiogram of 200 normal persons. J Mt Sinai Hosp NY 1950, 7:242–253.

    Google Scholar 

  7. Astrand I: Electrocardiogram record twice with in an 8 year interval in a group of 204 women and men. Act Med Scand 1965, 178:27–39.

    CAS  Google Scholar 

  8. Linhart JF, Laws JG, Satinsky JD: Maximum treadmill exercise electrocardiography in female patients. Circulation 1974, 50:1173–1178.

    PubMed  CAS  Google Scholar 

  9. Koppes G, McKiernan T, Bassan M, Froelicher VF: Treadmill exercise testing. Curr Probl Cardiol 1977, 8:1–15.

    Article  Google Scholar 

  10. Lewis WR, Amsterdam EA, Turnipseed S, et al.: Exercise stress testing in patients with angiographic normal coronary arteries: Similar frequency of false positive ischemic responses in males and females. Am J Cardiol 1978, 41:378.

    Google Scholar 

  11. Weiner DA, Ryan TJ, MCCabe CH, et al.: Exercise stress testing: correlations among history of angina, ST-segment recompose and prevalence of coronary artery disease in the Coronary Artery Surgery Study (CASS). N Engl J Med 1983, 301:230–235.

    Article  Google Scholar 

  12. Hlakty MA, Ortir DB, Harrell FE, et al.: Factors affecting sensitivity and specificity of exercise electrocardiography. Am J Med 1984, 77:64–71.

    Article  Google Scholar 

  13. Okin PM, Kligfield P: Gender-specific criteria and performance of the exercise electrocardiogram. Circulation 1995, 92:1209–1216.

    PubMed  CAS  Google Scholar 

  14. Goldberg N, Schifter D, Butte A, Stein RA: Comparison of ST heart rate analysis and standard ST segment analysis with respect to outcome of exercise thallium 201 imaging. Am J Cardiol 1995, 76:1097–1098.

    Article  PubMed  CAS  Google Scholar 

  15. Kwok Y, Kim C, Grady D, et al.: Meta-analysis of exercise testing to detect coronary artery disease in women. Am J Cardiol 1999, 83:660–666.

    Article  PubMed  CAS  Google Scholar 

  16. Jaffe MD: Effect of testosterone cypionate on post exercise ST segment depression. Br Heart J 1977, 39:1217.

    PubMed  CAS  Google Scholar 

  17. Williams JK, Adams MR, Herrington DM, Clarkson TB: Short term administration of estrogen and vascular response of athersclerotic coronary arteries. J Am Coll Cardiol 1992, 20:452–258.

    Article  PubMed  CAS  Google Scholar 

  18. Vaitevicius P, Wright JG, Fleg JL: Effect of estrogen replacement therapy on the ST segment response to postural and hyperventilatory stimuli. Am J Cardiol 1989, 64:1076–1078.

    Article  Google Scholar 

  19. Amanullah AM, Kiat H, Friedman JD, et al.: Adenosine technetium-99m sestamibi myocardial perfusion SPECT in owmen: diagnostic efficacy in detection of coronary artery disease. J Am Coll Cardiol 1996, 27:803–809.

    Article  PubMed  CAS  Google Scholar 

  20. Leppo JA: Comparison of pharmacologic steroagents. J Nucl Cardiol 1996, 3:522–526.

    Article  Google Scholar 

  21. Hanson CL, Crabbe D, Rubin S: Lower diagnostic accuracy of thallium-201 SPECT myocardial perfrusion imaging in women: An effect of smaller chamber size. J Am Coll Cardiol 1996, 28:1214–1219.

    Article  Google Scholar 

  22. Taillefer R, DePuey EG, Udelson JE, et al.: Comparative diagnostic accuracy of Tl-201 and Tc99m sestamibi SPECT imaging (perfusion and ECG gated SPECT) in detecting coronary artery disease in women. J Am Coll Cardiol 1997, 29:69–77.

    Article  PubMed  CAS  Google Scholar 

  23. Bateman TM, Heller GV, Johnson LL, et al.: Does attenuation correction add value to non-attenuation corrected ECG gated technetium-99m sestamibi SPECT [abstract]? J Nucl Cardiol 2003, 10:S91.

    Google Scholar 

  24. Johnson BD, Shaw LJ, Buchthal SD, et al.: Prognosis in women with myocardial ischemia in the absence of obstructive coronary disease: Results from the NIH-NHLBI-Sponsored Women’ Ischemia Syndrome Evaluation (WISE). Circulation 2004, 109:2993–2999.

    Article  PubMed  Google Scholar 

  25. Mark DB, Hlatky MA, Harrell FE, et al.: Exercise treadmill score for predicting prognosis in coronary artery disease. Ann Intern Med 1987, 106:793–800.

    PubMed  CAS  Google Scholar 

  26. Mark DB, Shaw L, Harrell FE, et al.: Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med 1991, 325:849–853.

    Article  PubMed  CAS  Google Scholar 

  27. Alexander KP, Shaw LJ, Shaw LK, et al.: Value of exercise treadmill testing in women. J Am Coll Cardiol 1998, 32:1957–1654.

    Google Scholar 

  28. Gulati M, Arnsdorf MF, Shaw LJ, et al.: Prognostic value of the duke treadmill Score in asymptomatic women. Am J Cardiol 2005, 96:369–375.

    Article  PubMed  Google Scholar 

  29. Gulati M, Pandey DK, Arnsdorf MF, et al.: Exercise capacity and risk of death in women: the St James Women Take Heart Project. Circulation 2003, 108:1554–1559.

    Article  PubMed  Google Scholar 

  30. Gibbons RJ Balady GJ, Bricker JT, et al.: A report of the ACC/AHA Taskforce on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). J Am Coll Cardiol 2002, 40:1531–1550.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Beth Israel Medical Center, 1st Avenue and 16th Street, New York, NY, 10003, USA

    Richard A. Stein MD

Authors
  1. Richard A. Stein MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nieca Goldberg MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Richard A. Stein MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Stein, R.A., Goldberg, N. Exercise electrocardiogram testing and imaging in women. Curr Cardio Risk Rep 1, 153–158 (2007). https://doi.org/10.1007/s12170-007-0025-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12170-007-0025-5

Keywords

Search

Navigation