[Clinical value of measuring systolic arterial blood pressure post-exercise for evaluation and diagnosis of coronary disease: comparative study between women and men].
It has been demonstrated that the ratio of the systolic blood pressure post-exercise to that at peak exercise (rSBP) is a criterion for diagnosis and severity of coronary artery disease (CAD) in men. No such demonstration has been attempted in women. We have compared SBP to classical signs of ischemia, such as ST segment depression and angina pectoris, in a group of 788 ambulatory patients of whom 357 were women. All underwent a bicycle ergometric test and a coronary angiogram. The prevalence of CAD at angiography was the same for both genders (women 43.5% and men 47%) with no significant difference in the number of vessels diseased. In patients with CAD, the rSBP was significantly more elevated than in others, at 1 minute (p < 0.01) and even more so at 3 minutes (p < 0.001) post-exercise, with no gender difference. The most discriminating value of rSBP at 3 minutes post-exercise for diagnosis of CAD was situated at 0.91 for sensitivity and specificity (receiver operating characteristic curve analysis). In the whole group sensitivity of rSBP is lower, while the specificity is greater than classical criteria of ischemia. The sensitivity of rSBP is poor for the diagnosis of single vessel disease, but of equal value compared to ST segment depression in the presence of multivessel disease, with no gender difference. The specificity of rSBP is higher than ST segment depression in women (p < 0.001) compared to men (p < 0.05). rSBP has a positive correlation with the number of coronary vessels diseased but not with the extent of ST segment depression. Our study demonstrates that rSBP at 3 minutes post-exercise is a less good diagnostic sign than the classical criteria of myocardial ischemia. However, rSBP has good specificity, particularly in women, thus reducing false positive tests related to ST segment depression. rSBP is also a marker of the severity of coronary artery disease.
Ciaroni
S
S
Service de cardiologie, Hôpital de la Tour, Meyrin-Genève.
Bloch
A
A
Cuenoud
L
L
Fournet
P C
PC
D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis; D001794:Blood Pressure; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis*; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013599:Systole