Division of Cardiovascular Medicine, University of California (Davis) Medical Center, Sacramento, California, USA.
Am J Cardiol. 2012 Dec 1;110(11):1619-22. doi: 10.1016/j.amjcard.2012.07.027. Epub 2012 Sep 24.
The exercise treadmill test (ETT) in women has been limited by a low positive predictive value (PPV) for coronary artery disease (CAD). However, the reliability of previous studies was unsatisfactory because of the inclusion of younger women with a low prevalence of CAD. To further evaluate the diagnostic properties of the ETT in women, we evaluated a group of women with chest pain who had a positive ETT result and subsequent coronary angiography. Of the 111 women, 56 had significant CAD on angiogram, yielding a PPV of 51% for the group. However, inclusion in the analysis of several pretest attributes and specific exercise test responses improved the PPV of the ETT. Age had a major effect, with the youngest group (35 to 50 years old) having a PPV of 36% compared to 68% in the oldest group (>65 years old). Several specific exercise responses (ST-segment depression >2 mm and delayed ST-segment recovery >3.0 minutes) further separated true from false positives across all age groups, increasing the PPV to approximately 80%. Onset of ischemia at a relatively low cardiac workload of <80% maximum predicted heart rate was not a significant predictor. In conclusion, the standard ETT should remain the test of choice in ambulatory women with chest pain and no significant abnormalities on baseline electrocardiogram especially in those >65 years of age.
女性运动平板试验（ETT）由于对冠状动脉疾病（CAD）的阳性预测值（PPV）较低而受到限制。然而，由于包括 CAD 患病率较低的年轻女性在内，以前研究的可靠性并不令人满意。为了进一步评估 ETT 在女性中的诊断特性，我们评估了一组胸痛且 ETT 结果阳性并随后进行冠状动脉造影的女性。在 111 名女性中，56 名女性的冠状动脉造影显示有明显的 CAD，其阳性预测值为 51%。然而，将几个术前特征和特定的运动试验反应纳入分析可以提高 ETT 的阳性预测值。年龄有重大影响，年龄最小的组（35 至 50 岁）的阳性预测值为 36%，而年龄最大的组（>65 岁）的阳性预测值为 68%。在所有年龄组中，几个特定的运动反应（ST 段压低>2mm 和 ST 段恢复延迟>3.0 分钟）进一步区分了真阳性和假阳性，阳性预测值提高到约 80%。在相对较低的心脏工作量（<80%最大预测心率）时出现缺血不是一个重要的预测因素。总之，对于有胸痛且基线心电图无明显异常的女性，特别是年龄>65 岁的女性，标准 ETT 仍应作为首选的检查方法。
