D'Antono B, Dupuis Gilles, Fortin Christophe, Arsenault A, Burelle Denis
Department of Psychosomatic Medicine, Montreal Heart Institute, Canada. bianca.d'
Can J Cardiol. 2006 Apr;22(5):411-7. doi: 10.1016/s0828-282x(06)70927-8.
To examine the capacity of angina and related symptoms experienced during exercise-stress testing to detect the presence of ischemia, controlling for other clinical factors.
The authors undertook a prospective study of 482 women and 425 men (mean age 58 years) undergoing exercise stress testing with myocardial perfusion imaging. One hundred forty-six women and 127 men reported chest pain, and of these, 25% of women and 66% of men had myocardial perfusion imaging evidence of ischemia during testing. The present article focuses on patients with chest pain during testing.
Outcome measures included chest pain localization, extension, intensity and quality, as well as the presence of various nonpain-related symptoms. Backward logistical regression analyses were performed separately on men and women who had experienced chest pain during testing.
Men who described their chest pain as 'heavy' were 4.6 times more likely to experience ischemia during testing (P=0.039) compared with other men, but this pain descriptor only slightly improved accuracy of prediction beyond that provided by control variables. In women, several symptoms added to the sensitivity of the prediction, such as a numb feeling in the face or neck region (OR 4.5; P=0.048), a numb feeling in the chest area (OR 14.6; P=0.003), muscle tension (OR 5.2; P=0.013), and chest pain that was described as hot or burning (OR 4.3; P=0.014).
A more refined evaluation of symptoms experienced during testing was particularly helpful in improving detection of ischemia in women, but not in men. Attention to these symptoms may favour timely diagnosis of myocardial perfusion defects in women.
在控制其他临床因素的情况下，研究运动负荷试验期间出现的心绞痛及相关症状检测心肌缺血的能力。
作者对482名女性和425名男性（平均年龄58岁）进行了一项前瞻性研究，这些受试者均接受了运动负荷试验及心肌灌注成像检查。146名女性和127名男性报告有胸痛症状，其中，25%的女性和66%的男性在试验期间有心肌灌注成像显示的心肌缺血证据。本文重点关注试验期间有胸痛症状的患者。
观察指标包括胸痛的定位、范围、强度和性质，以及各种非疼痛相关症状的出现情况。对试验期间经历胸痛的男性和女性分别进行向后逻辑回归分析。
与其他男性相比，将胸痛描述为“沉重”的男性在试验期间发生心肌缺血的可能性高4.6倍（P=0.039），但与对照变量相比，这种疼痛描述仅略微提高了预测准确性。在女性中，有几种症状增加了预测的敏感性，如面部或颈部麻木感（比值比4.5；P=0.048）、胸部麻木感（比值比14.6；P=0.003）、肌肉紧张（比值比5.2；P=0.013），以及描述为热或灼痛的胸痛（比值比4.3；P=0.014）。
对试验期间出现的症状进行更精细的评估对提高女性心肌缺血的检测特别有帮助，但对男性则不然。关注这些症状可能有助于及时诊断女性的心肌灌注缺损。
