Detection of exercise-induced myocardial ischemia from symptomatology experienced during testing in men and women.
OBJECTIVE
To examine the capacity of angina and related symptoms experienced during exercise-stress testing to detect the presence of ischemia, controlling for other clinical factors.


METHODS
The authors undertook a prospective study of 482 women and 425 men (mean age 58 years) undergoing exercise stress testing with myocardial perfusion imaging. One hundred forty-six women and 127 men reported chest pain, and of these, 25% of women and 66% of men had myocardial perfusion imaging evidence of ischemia during testing. The present article focuses on patients with chest pain during testing.


METHODS
Outcome measures included chest pain localization, extension, intensity and quality, as well as the presence of various nonpain-related symptoms. Backward logistical regression analyses were performed separately on men and women who had experienced chest pain during testing.


RESULTS
Men who described their chest pain as 'heavy' were 4.6 times more likely to experience ischemia during testing (P=0.039) compared with other men, but this pain descriptor only slightly improved accuracy of prediction beyond that provided by control variables. In women, several symptoms added to the sensitivity of the prediction, such as a numb feeling in the face or neck region (OR 4.5; P=0.048), a numb feeling in the chest area (OR 14.6; P=0.003), muscle tension (OR 5.2; P=0.013), and chest pain that was described as hot or burning (OR 4.3; P=0.014).


CONCLUSIONS
A more refined evaluation of symptoms experienced during testing was particularly helpful in improving detection of ischemia in women, but not in men. Attention to these symptoms may favour timely diagnosis of myocardial perfusion defects in women.
D'Antono
B
B
Department of Psychosomatic Medicine, Montreal Heart Institute, Canada. bianca.d'antono@internet.uqam.ca
Dupuis
Gilles
G
Fortin
Christophe
C
Arsenault
A
A
Burelle
Denis
D
D002637:Chest Pain / Q000209:etiology; D005080:Exercise Test; D005260:Female; D006801:Humans; D006987:Hypesthesia / Q000209:etiology; D016015:Logistic Models; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis*; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013546:Sweating