Sharma Shilpa, Mehta Puja K, Arsanjani Reza, Sedlak Tara, Hobel Zachary, Shufelt Chrisandra, Jones Erika, Kligfield Paul, Mortara David, Laks Michael, Diniz Márcio, Bairey Merz C Noel
Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California.
Emory Women's Heart Center, Emory University, Atlanta, Georgia.
Clin Cardiol. 2018 Aug;41(8):1044-1048. doi: 10.1002/clc.23000. Epub 2018 Aug 17.
The utility of exercise-induced ST-segment depression for diagnosing ischemic heart disease (IHD) in women is unclear.
Based on evidence that IHD pathophysiology in women involves coronary vascular dysfunction, we hypothesized that coronary vascular dysfunction contributes to exercise electrocardiography (Ex-ECG) ST-depression in the absence of obstructive coronary artery disease, so-called false positive results. We tested our hypothesis in a pilot study evaluating the relationship between peripheral vascular endothelial function and Ex-ECG.
Twenty-nine asymptomatic women without cardiac risk factors underwent maximal Bruce protocol exercise treadmill testing and peripheral endothelial function assessment using peripheral arterial tonometry (Itamar EndoPAT 2000) to measure reactive hyperemia index (RHI). The relationship between RHI and Ex-ECG ST-segment depression was evaluated using logistic regression and differences in subgroups using 2-tailed t tests.
Mean age was 54 ± 7 years, body mass index 25 ± 4 kg/m , and RHI 2.51 ± 0.66. Three women (10%) had RHI <1.68, consistent with abnormal peripheral endothelial function, whereas 18 women (62%) met criteria for positive Ex-ECG based on ST-segment depression in contiguous leads. Women with and without ST-segment depression had similar baseline and exercise vital signs, metabolic equivalents achieved, and RHI (all P > 0.05). RHI did not predict ST-segment depression.
Our pilot study demonstrates high prevalence of exercise-induced ST-segment depression in asymptomatic, middle-aged, overweight women. Peripheral vascular endothelial dysfunction did not predict Ex-ECG ST-segment depression. Further work is needed to investigate the utility of vascular endothelial testing and Ex-ECG for IHD diagnostic and management purposes in women.
运动诱发的ST段压低用于诊断女性缺血性心脏病（IHD）的效用尚不清楚。
基于女性IHD病理生理学涉及冠状动脉血管功能障碍的证据，我们假设冠状动脉血管功能障碍在无阻塞性冠状动脉疾病（即所谓的假阳性结果）的情况下导致运动心电图（Ex-ECG）ST段压低。我们在一项评估外周血管内皮功能与Ex-ECG之间关系的初步研究中检验了我们的假设。
29名无心脏危险因素的无症状女性接受了最大Bruce方案运动平板试验，并使用外周动脉张力测量法（Itamar EndoPAT 2000）评估外周内皮功能，以测量反应性充血指数（RHI）。使用逻辑回归评估RHI与Ex-ECG ST段压低之间的关系，并使用双尾t检验评估亚组间差异。
平均年龄为54±7岁，体重指数为25±4 kg/m²，RHI为2.51±0.66。3名女性（10%）的RHI<1.68，符合外周内皮功能异常，而18名女性（62%）根据相邻导联的ST段压低符合Ex-ECG阳性标准。有和没有ST段压低的女性在基线和运动生命体征、达到的代谢当量以及RHI方面相似（所有P>0.05）。RHI不能预测ST段压低。
我们的初步研究表明，无症状、中年、超重女性中运动诱发的ST段压低患病率很高。外周血管内皮功能障碍不能预测Ex-ECG ST段压低。需要进一步开展工作，以研究血管内皮检测和Ex-ECG在女性IHD诊断和管理中的效用。
