Exercise Electrocardiography in Women with Suspected Coronary Disease
Exercise testing is a commonly used tool for the evaluation of atherosclerotic coronary artery disease. ST-segment depression has been a focus of interest as a marker of ischemia since at least 1928 (1). As early as 1950. Scherlis et al noted that, compared to men, normal women were more likely to have ST-segment abnormalities after exercise (2). Since then, most (if not all) studies have indicated a higher false-positive rate for ST-segment changes in women compared with men. From this body of literature emphasizing the higher false-positive rate comes the current perception that exercise electrocardiography is inherently less useful in women compared with men. The following review will examine recent developments in the accuracy of the exercise test in women, the role of hormones in the false-positive response, and the role of exercise testing in the evaluation of women with symptoms of suspected coronary disease.
KeywordsDepression Ischemia Estrogen Adenosine Progesterone
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- 2.Scherlis L, Sandberg AA, Werner J, et al. Effects of single and double two-step exercise tests upon electrocardiogram of 200 normal persons. J Mt Sinai Hosp 1950;17:242–253.Google Scholar
- 10.Jaffe MD. Effect of oestrogens on postexercise electrocardiogram. Br Heart J 1977;38: I299–1303.Google Scholar
- 12.Rosano G, Rosano GMC, Sarrel PM, et al. Medroxyprogestcronc but not natural progesterone reverses the beneficial effect of estradiol 17heta upon exercise-induced myocardial ischemia. Circulation1996;94:I-18 (abstract).Google Scholar
- 15.Morise AP. Progestin therapy as a variable auxiliary to established predictors of positive exercise tests in women. JNoninvasive Cardiol 1997; 1:27–32.Google Scholar
- 16.Rovang KS, Arouni AJ, Mohiuddin SM, et al. Oral estrogen replacement therapy reduces the diagnostic accuracy of exercise stress tests in women. J Am Coll Cardiol 2000; 35:211 (abstract)Google Scholar
- 20.Leiberman EH, Gerhard MD, Uehata A, et al. Estrogen improves endothelium-dependent flow-mediated vasodilation in postmenopausal women. Ann Intern Med 1994;121:93641.Google Scholar
- 23.Schlant RC, Blomqvist CG, Brandenburg RO, et al. Guidelines for exercise testing: a report of the joint American College of Cardiology/American Heart Association task force on assessment of cardiovascular procedures (subcommittee on exercise testing). Circulation I986;653A--667A.Google Scholar
- 25.Morise AP. Are the ACC/AHA guidelines for exercise testing for suspected coronary disease correct? Chest 2000 (in press).Google Scholar
- 26.. Morise AP, Haddad WI, Beckner D. Development and validation of a clinical score to estimate the probability of coronary artery disease in men and women presenting with suspected coronary disease. Am JMed 1997;102:350–6.Google Scholar
- 32.Zellweger Mi, Lewin HC, Thompson TD, et al. Is the Duke treadmill score age and gender biased? Circulation 1999;100:I-505 (abstract).Google Scholar
- 35.Reis SE, Holubkov R, Lee JS, et al. Coronary flow velocity response to adenosine characterizes coronary microvascular function in women with chest pain and no obstructive coronary disease. Results from the pilot phase of the Women’s Ischemia Syndrome Evaluation (WISE) Study. JAm Coll Cardiol 1999;33:1469–75.CrossRefGoogle Scholar