Lewis Jannet F, McGorray Susan, Lin Lang, Pepine Carl J, Chaitman Bernard, Doyle Mark, Edmundowicz Daniel, Sharaf Barry L, Merz C Noel Bairey
WISE Clinical Centers, Division of Cardiology, University of Florida, Gainesville, Fla, USA.
Am Heart J. 2005 Mar;149(3):527-33. doi: 10.1016/j.ahj.2004.03.068.
Exercise testing, a major diagnostic modality in individuals with suspected coronary artery disease (CAD), has in general demonstrated less overall diagnostic accuracy in women compared to men. As part of the WISE, a modified protocol was examined with the intention of improving reliability of exercise testing.
Criteria for entry in the WISE study include clinically indicated coronary angiography. Exercise testing was performed using a protocol modified to be more appropriate for women. The study population consisted of 96 women, mean age of 55.8 y (range 34-77), who completed exercise treadmill test (ETT). Most (78%) were postmenopausal; 96% had >or =2 risk factors for CAD.
By core laboratory angiography, 29/96 women had stenosis > or =50% in at least one coronary artery. Of these 29 women, 9 had abnormal ETT, yielding overall sensitivity of 31%. The remaining 20 women had normal (12/29, 41%) or nondiagnostic (8/29, 28%) studies. Among the 67 women with minimal or no coronary stenosis, 35 had no ischemic ST-segment changes during ETT, yielding overall specificity of 52%. Analysis with exclusion of women with nondiagnostic studies yielded sensitivity and specificity of 43% and 66%, respectively. The presence of coronary artery stenosis and inability to perform ETT, but not results of testing, predicted the outcomes of myocardial infarction, heart failure, and death.
Exercise treadmill test appears to be of limited diagnostic value in women with suspected myocardial ischemia referred for coronary angiography. Sensitivity and specificity remain poor even with modified exercise protocol and core laboratory angiographic analysis. These findings merit consideration in view of current guidelines that recommend exercise testing in women with suspected CAD.
运动试验是疑似冠心病（CAD）患者的主要诊断方法，总体而言，与男性相比，其在女性中的诊断准确性较低。作为女性缺血综合征评价（WISE）研究的一部分，对一种改良方案进行了研究，旨在提高运动试验的可靠性。
WISE研究的入选标准包括临床指征性冠状动脉造影。运动试验采用改良方案，使其更适合女性。研究人群包括96名女性，平均年龄55.8岁（范围34 - 77岁），她们完成了运动平板试验（ETT）。大多数（78%）为绝经后女性；96%有≥2个CAD危险因素。
经核心实验室冠状动脉造影，96名女性中有29名至少有一支冠状动脉狭窄≥50%。在这29名女性中，9名ETT异常，总体敏感性为31%。其余20名女性检查结果正常（12/29，41%）或无法诊断（8/29，28%）。在67名冠状动脉狭窄轻微或无狭窄的女性中，35名在ETT期间无缺血性ST段改变，总体特异性为52%。排除无法诊断的女性进行分析，敏感性和特异性分别为43%和66%。冠状动脉狭窄的存在以及无法进行ETT，而非检查结果，可预测心肌梗死、心力衰竭和死亡的结局。
对于因疑似心肌缺血而接受冠状动脉造影的女性，运动平板试验的诊断价值似乎有限。即使采用改良的运动方案和核心实验室冠状动脉造影分析，敏感性和特异性仍然较差。鉴于当前指南建议对疑似CAD的女性进行运动试验，这些发现值得考虑。
