title: Exercise treadmill testing using a modified exercise protocol in women with suspected myocardial ischemia: findings from the National Heart, Lung and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE).
abstract: BACKGROUND
  Exercise testing, a major diagnostic modality in individuals with suspected coronary artery disease (CAD), has in general demonstrated less overall diagnostic accuracy in women compared to men. As part of the WISE, a modified protocol was examined with the intention of improving reliability of exercise testing.
  
  
  METHODS
  Criteria for entry in the WISE study include clinically indicated coronary angiography. Exercise testing was performed using a protocol modified to be more appropriate for women. The study population consisted of 96 women, mean age of 55.8 y (range 34-77), who completed exercise treadmill test (ETT). Most (78%) were postmenopausal; 96% had >or =2 risk factors for CAD.
  
  
  RESULTS
  By core laboratory angiography, 29/96 women had stenosis > or =50% in at least one coronary artery. Of these 29 women, 9 had abnormal ETT, yielding overall sensitivity of 31%. The remaining 20 women had normal (12/29, 41%) or nondiagnostic (8/29, 28%) studies. Among the 67 women with minimal or no coronary stenosis, 35 had no ischemic ST-segment changes during ETT, yielding overall specificity of 52%. Analysis with exclusion of women with nondiagnostic studies yielded sensitivity and specificity of 43% and 66%, respectively. The presence of coronary artery stenosis and inability to perform ETT, but not results of testing, predicted the outcomes of myocardial infarction, heart failure, and death.
  
  
  CONCLUSIONS
  Exercise treadmill test appears to be of limited diagnostic value in women with suspected myocardial ischemia referred for coronary angiography. Sensitivity and specificity remain poor even with modified exercise protocol and core laboratory angiographic analysis. These findings merit consideration in view of current guidelines that recommend exercise testing in women with suspected CAD.
authors.affiliation: WISE Clinical Centers, Division of Cardiology, University of Florida, Gainesville, Fla, USA. jlewis@mfa.gwu.edu
authors.forename: Jannet F
authors.initials: JF
authors.lastname: Lewis
authors.forename: Susan
authors.initials: S
authors.lastname: McGorray
authors.forename: Lang
authors.initials: L
authors.lastname: Lin
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Pepine
authors.forename: Bernard
authors.initials: B
authors.lastname: Chaitman
authors.forename: Mark
authors.initials: M
authors.lastname: Doyle
authors.forename: Daniel
authors.initials: D
authors.lastname: Edmundowicz
authors.forename: Barry L
authors.initials: BL
authors.lastname: Sharaf
authors.forename: C Noel Bairey
authors.initials: CN
authors.lastname: Merz
mesh_terms: D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000150:complications / Q000175:diagnosis*; D004562:Electrocardiography; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000209:etiology; D012680:Sensitivity and Specificity; D016387:Women's Health