title: The specificity of exercise electrocardiography in women grouped by estrogen status.
abstract: We compared the specificity of exercise electrocardiography in 1880 men and 1818 women with women grouped by menopausal and estrogen replacement status. Specificity for > or = 1 mm horizontal or downsloping ST-segment depression was determined using angiography in 781 patients and using two other nonangiography-based methods (a pretest probability-based method and a predictive accuracy-based method) in all patients. Using angiography, the specificities+/-SE were 84 +/- 2 for men, 79 +/- 3 for women, 81 +/- 5 for premenopausal women, 81 +/- 4 for postmenopausal women without estrogen replacement, and 77 +/- 5 for women on estrogen replacement. None of these were significantly different. For all patients, the respective specificities using the probability and predictive accuracy-based methods were 97 +/- 1 and 94 +/- 1 for men, 90 +/- 1 and 88 +/- 1 for women, 97 +/- 1 and 92 +/- 2 for premenopausal women, 92 +/- 4 and 88 +/- 3 for postmenopausal women without estrogen replacement, and 85 +/- 4 and 81 +/- 3 for women on estrogen replacement. (Men vs. all women groups except premenopausal women-P < 0.05). Therefore, the premenopausal women had significantly greater specificity than women on estrogen replacement (P < 0.001) and no difference in specificity with men. Women on estrogen replacement had a significantly lower specificity than postmenopausal women not on estrogen replacement (P < 0.05). These results suggest that estrogen replacement therapy and not naturally occurring estrogen has a role in producing false positive exercise electrocardiograms in women.
authors.affiliation: Department of Medicine, HSC-South, West Virginia University School of Medicine, Morgantown 26506-9157, USA.
authors.forename: A P
authors.initials: AP
authors.lastname: Morise
authors.forename: R
authors.initials: R
authors.lastname: Beto
mesh_terms: D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000175:diagnosis* / Q000503:physiopathology; D004562:Electrocardiography; D015914:Estrogen Replacement Therapy; D004967:Estrogens / Q000494:pharmacology* / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017698:Postmenopause / Q000502:physiology; D011237:Predictive Value of Tests; D017697:Premenopause / Q000502:physiology; D012680:Sensitivity and Specificity; D012737:Sex Factors; D018709:Statistics, Nonparametric
chemical_list: D004967:Estrogens