1 Cardiac Imaging Division Alkmaar, Northwest Clinics , Alkmaar, The Netherlands .
2 Department of Nuclear Medicine, Northwest Clinics , Alkmaar, The Netherlands .
J Womens Health (Larchmt). 2018 Apr;27(4):476-484. doi: 10.1089/jwh.2017.6433. Epub 2018 Jan 3.
The value of exercise electrocardiogram (ExECG) in symptomatic female patients with low to intermediate risk for significant coronary artery disease (CAD) has been under debate for many years, and nondiagnostic or even erroneous test results are frequently encountered. Cardiac-CT may be more appropriate to exclude CAD in women. This study compares the results of ExECGs with those of cardiac-CTs, performed within a time frame of 1 month in an all-comers female chest pain population.
Five hundred fifty-one consecutive female patients from a patient registry were included. ExECGs were negative in 324 (59%), positive in 14 (3%), and nondiagnostic in 213 (39%) patients. CAD was revealed by cardiac-CT in 57% of the women with negative ExECG. No signs of CAD were present on cardiac-CT in 64% of the women with a positive ExECG. Cardiac-CT showed presence of CAD in 268/551 (49%) patients, of whom 56/268 (21%) was diagnosed with ≥50% stenosis. The ExECG of the latter group was negative in 26 (46%), inconclusive in 29 (52%), and positive in 1 (2%). Considering ≥50% stenosis at cardiac-CT as the reference, sensitivity, specificity, PPV, and NPV of ExECG for the present population were 3.7%, 95.7%, 7.1%, and 91.7%, respectively. Similar diagnostic performance was calculated when considering ≥70% stenosis at cardiac-CT as the reference.
ExECG failed to detect CAD in more than half of this cohort and in almost half of women with >50% stenosis at cardiac-CT. Importantly, no CAD was detected by cardiac-CT in 64% of women with a positive ExECG. ExECG is therefore questionable as a diagnostic strategy in women with low-to-intermediate risk of CAD, although prospective studies are warranted to determine whether replacing ExECG by cardiac-CT provides better prognoses.
运动心电图（ExECG）在低至中度有明显冠状动脉疾病（CAD）风险的有症状女性患者中的价值多年来一直存在争议，并且经常遇到非诊断性甚至错误的测试结果。心脏 CT 可能更适合排除女性的 CAD。本研究比较了在所有女性胸痛患者中在 1 个月内进行的 ExECG 和心脏 CT 的结果。
从患者登记处纳入 551 名连续女性患者。324 例（59%）ExECG 阴性，14 例（3%）阳性，213 例（39%）非诊断性。心脏 CT 显示阴性 ExECG 的女性中有 57%存在 CAD。阳性 ExECG 的女性中，64%的心脏 CT 无 CAD 迹象。心脏 CT 显示 551 例患者中有 268 例（49%）存在 CAD，其中 56 例（21%）诊断为≥50%狭窄。后一组的 ExECG 阴性 26 例（46%），不确定 29 例（52%），阳性 1 例（2%）。考虑心脏 CT 上≥50%狭窄为参考，本人群的 ExECG 的敏感性、特异性、PPV 和 NPV 分别为 3.7%、95.7%、7.1%和 91.7%。当考虑心脏 CT 上≥70%狭窄为参考时，计算出相似的诊断性能。
ExECG 在该队列的一半以上以及在心脏 CT 上有>50%狭窄的女性中未能检测到 CAD。重要的是，在 ExECG 阳性的女性中，有 64%的心脏 CT 未检测到 CAD。因此，ExECG 作为低至中度 CAD 风险女性的诊断策略值得怀疑，尽管需要前瞻性研究来确定用心脏 CT 替代 ExECG 是否提供更好的预后。
