Grosse-Heitmeyer W, Huber T
Medizinische Klinik-Kardiologie, St. Bonifatius Hospital, Lingen/Ems.
Med Klin (Munich). 1994 May 15;89(5):233-9.
Problems are often encountered in evaluating the exercise stress ECG in women due to frequent false pathological findings. Besides the exercise ECG in the noninvasive diagnosis of coronary heart disease (CHD), the dipyridamole test is often used. As yet little is known about, whether a similarly high incidence of false positive test results occur under provocation with dipyridamole in women as in the exercise stress ECG.
In the present study the results of the dipyridamole test and of the coronary angiography in 218 patients, diagnosed as suspected of having CHD, were compared, especially allowing for specific sex differences.
The prevalence of CHD in women was 17.8% and 56.1% in men. Under provocation with dipyridamole allowing for the indicator angina pectoris, the incidence of a false positive test results in relation to a significant coronary stenosis is higher in women with 80.5% than in men with 36.4% (p < 0.001). By contrast, men have a significantly higher rate of false negative test findings (40.9% to 11.1%; p < 0.001). Whereas the women obtained a sensitivity of 87.5%, the rating for men was 70.1%. Specificity was 21.6% for women and 48.7% for men. Test efficiency for men was 60.7% whereas for women 33.3% were calculated. The reaction of heart rate (significant increase of 33%) and systolic and diastolic blood pressure (no significant changes) did not reveal any relevant differences between men and women during the dipyridamole test.
For patients with CHD similar diagnostic uncertainties occurred relating to specific sex differences in the results of the dipyridamole test, just like those known from the exercise ECG.
由于频繁出现假阳性结果，在评估女性运动应激心电图时经常遇到问题。除了运动心电图用于冠心病（CHD）的无创诊断外，双嘧达莫试验也经常被使用。然而，对于女性在双嘧达莫激发试验下是否会出现与运动应激心电图类似的高假阳性结果发生率，目前所知甚少。
在本研究中，对218例被诊断为疑似冠心病的患者进行了双嘧达莫试验和冠状动脉造影结果的比较，特别考虑了特定的性别差异。
女性冠心病患病率为17.8%，男性为56.1%。在双嘧达莫激发试验中，以心绞痛为指标，女性与显著冠状动脉狭窄相关的假阳性试验结果发生率为80.5%，高于男性的36.4%（p<0.001）。相比之下，男性的假阴性试验结果发生率显著更高（40.9%对11.1%；p<0.001）。女性的敏感性为87.5%，男性为70.1%。女性的特异性为21.6%，男性为48.7%。男性的试验效率为60.7%，而女性为33.3%。在双嘧达莫试验期间，心率反应（显著增加33%）以及收缩压和舒张压（无显著变化）在男性和女性之间未显示出任何相关差异。
对于冠心病患者，双嘧达莫试验结果存在与运动心电图类似的特定性别差异相关的诊断不确定性。
