Walling A D, Crawford M H
Division of Cardiology, University of Texas Health Science Center at San Antonio.
Coron Artery Dis. 1993 Sep;4(9):783-9. doi: 10.1097/00019501-199309000-00005.
The frequent occurrence of false-positive results of standard electrocardiographic (ECG) treadmill exercise testing in women limits its diagnostic value. In men, a commercially available computer-derived treadmill exercise score (TES), which quantifies the exercise ECG, has been reported to have high diagnostic accuracy. The purpose of this study was to test TES accuracy in women.
We prospectively evaluated 87 middle-aged women with chest pain and no previous history of cardiac events who underwent exercise testing and coronary arteriography (Group 1). Also, in 15 young symptomatic women with mitral valve prolapse and 15 age- and sex-matched controls (Group 2) we compared the TES score with standard exercise testing. In 25 Group 1 patients, TES could not be evaluated because of technical reasons.
By standard ECG criteria, 18 out of the 28 women in Group 1 with coronary artery disease (55%) had a false-positive test, whereas the TES score reduced the false positives to 5 (15%, P < 0.001). In Group 2, the false-positive rate was improved from 12 (40%) to zero with TES (P < 0.001). Overall specificity was thus improved from 52% to 92% by TES (P < 0.0001). There was a trend towards improving the positive predictive value (52% versus 74%) and diagnostic accuracy (57% versus 69%) (P = 0.1), but sensitivity and negative predictive value were not improved with TES.
The treadmill exercise score improves the specificity of exercise ECG especially in women with mitral valve prolapse and atypical chest pain, but its overall utility and accuracy in women is lower than that reported in men.
标准心电图平板运动试验在女性中频繁出现假阳性结果，限制了其诊断价值。在男性中，一种商业化的计算机衍生平板运动评分（TES），可对运动心电图进行量化，据报道具有较高的诊断准确性。本研究的目的是测试TES在女性中的准确性。
我们前瞻性地评估了87名有胸痛且无既往心脏事件史的中年女性，她们接受了运动试验和冠状动脉造影（第1组）。此外，在15名有症状的年轻二尖瓣脱垂女性和15名年龄及性别匹配的对照组（第2组）中，我们将TES评分与标准运动试验进行了比较。在第1组的25名患者中，由于技术原因无法评估TES。
根据标准心电图标准，第1组中28名患有冠状动脉疾病的女性中有18名（55%）试验结果为假阳性，而TES评分将假阳性减少至5名（15%，P<0.001）。在第2组中，TES使假阳性率从12名（40%）降至零（P<0.001）。因此，TES使总体特异性从52%提高到92%（P<0.0001）。TES有提高阳性预测值（52%对74%）和诊断准确性（57%对69%）的趋势（P=0.1），但TES并未提高敏感性和阴性预测值。
平板运动评分提高了运动心电图的特异性，尤其是在二尖瓣脱垂和非典型胸痛的女性中，但它在女性中的总体效用和准确性低于男性中的报道。
