[The noninvasive diagnosis of coronary heart disease in women. The exercise ECG or ST-segment analysis in the long-term ECG?].
The diagnostic value of an exercise ECG in women with the clinical symptoms of stable angina is limited because of its low accuracy in demonstrating coronary heart disease. A study of ambulatory patients was undertaken, involving 143 men and 29 women (mean age 55 [37-70] years), to determine whether ST-segment analysis of the 24-hour ECG gives better results, the coronary arteriogram providing the standard of comparison. 24-hour monitoring and the exercise ECG gave similar diagnostic results (66% vs 67%) in the 143 men. But in the 29 women 24-hour monitoring was diagnostically superior to the exercise ECG (76% vs 45%; P less than 0.01), as a result of a significantly higher specificity (64% vs 29%; P less than 0.05) and a tendency towards higher sensitivity (87% vs 60%; P = 0.13). As expected, the accuracy of the exercise ECG was thus lower in women than in men (P less than 0.05). There were no significant gender-specific differences for accuracy of 24-hour monitoring (76% in women, 66% in men; P less than 0.15). These data indicate that in women ST-segment analysis of the 24-hour ECG is better than the exercise ECG for demonstrating coronary heart disease.
Hoberg
E
E
Abteilung Innere Medizin III, Medizinische Universitätsklinik und Poliklinik, Heidelberg.
Kunze
B
B
König
J
J
Kabel
Y
Y
Kübler
W
W
D000787:Angina Pectoris / Q000175:diagnosis / Q000453:epidemiology; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis* / Q000453:epidemiology; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005069:Evaluation Studies as Topic; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012727:Sex Characteristics