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Am J Cardiol. 2012 Dec 1;110(11):1619-22. doi: 10.1016/j.amjcard.2012.07.027. Epub 2012 Sep 24.

Improving the positive predictive value of exercise testing in women for coronary artery disease.

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  • 1Division of Cardiovascular Medicine, University of California (Davis) Medical Center, Sacramento, California, USA.

Abstract

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.

Copyright © 2012 Elsevier Inc. All rights reserved.

PMID:
23018079
[PubMed - indexed for MEDLINE]
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