title: Detection of coronary artery disease in postmenopausal women: the significance of integrated stress imaging tests in a 4-year prognostic study.
abstract: BACKGROUND
  The present prospective study investigated whether a combined approach integrating two different stress imaging modalities may improve the diagnostic accuracy and prognostic impact of non-invasive coronary artery disease (CAD) tests in postmenopausal women. In women non-invasive tests for detecting CAD are less accurate than in men, leading to a high proportion of unnecessary coronary angiographies (CAs).
  
  
  METHODS
  424 consecutive postmenopausal women (mean 61 ± 7 years, mean Reynolds Risk Score 13 ± 3 %) with symptoms suggestive of CAD were prospectively included and followed up for 4 ± 1 years. Each patient underwent CA, stress cardiovascular magnetic resonance (CMR) by adenosine, dobutamine stress echocardiography (DSE) and single-photon emission computed tomography (SPECT) within 7 ± 3 days.
  
  
  RESULTS
  Anatomically obstructive coronary artery disease (≥50 % diameter stenosis) was present in 157 women (37 %). The combination of two stress imaging modalities significantly increased the positive predictive values (PPV) to 90 ± 3, 88 ± 3 and 87 ± 2 % for CMR/DSE, DSE/SPECT and CMR/SPECT, respectively. For patients with negative combined test results, the survival analysis showed a 4-year cumulative event-free survival rate of 96-97 % for all combinations. This new approach is cost effective due to the resulting reduction in unnecessary CAs (with potential side effects and corresponding therapies) as well as reducing hospitalization time.
  
  
  CONCLUSIONS
  In symptomatic postmenopausal women, combination of two negative stress imaging results significantly increases the PPV for detection of CAD and excludes future cardiovascular events with high accuracy. This approach may be applied to improve the prognostic precision of non-invasive CAD tests and to avoid unnecessary CAs.
authors.affiliation: Department of Cardiology, RWTH Aachen University, Aachen, Germany, mibecker@ukaachen.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Becker
authors.forename: Anne
authors.initials: A
authors.lastname: Hundemer
authors.forename: Christian
authors.initials: C
authors.lastname: Zwicker
authors.forename: Ertunc
authors.initials: E
authors.lastname: Altiok
authors.forename: Thomas
authors.initials: T
authors.lastname: Krohn
authors.forename: Felix M
authors.initials: FM
authors.lastname: Mottaghy
authors.forename: Christina
authors.initials: C
authors.lastname: Lente
authors.forename: Malte
authors.initials: M
authors.lastname: Kelm
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Marx
authors.forename: Rainer
authors.initials: R
authors.lastname: Hoffmann
mesh_terms: D000241:Adenosine; D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D018572:Disease-Free Survival; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D064847:Multimodal Imaging; D017698:Postmenopause; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine