title: Diagnostic accuracy of treadmill exercise tests among Chinese women with coronary artery diseases: A systematic review and meta-analysis.
abstract: BACKGROUND
  The treadmill exercise test (TET) is one of the most common noninvasive diagnosis approaches for ischemic heart diseases, but potential reduction of TET accuracy among Chinese female patients was ignored by most studies, especially in perimenopause women. Hence, we aim to perform a systematic review and meta-analysis evaluating the TET diagnostic accuracy for Chinese women compared with coronary angiography (CAG).
  
  
  METHODS
  PubMed, MEDLINE, EMBASE, CNKI and WANFANG (1990 to 2015) were performed to identify studies assessing the diagnostic accuracy of TET versus CAG. Random effects modeling strategies were used to produce summary receiver operating characteristic (SROC) curves, including overall estimates for sensitivity and specificity.
  
  
  RESULTS
  A total of 19 studies involving 2396 Chinese females were included in our systematic review. TET has moderate levels of sensitivity (0.80) and specificity (0.65) to detect coronary artery stenoses in female patients with suspected coronary artery diseases, generating 0.79 of the area under the curve (AUC). In subgroup analyses, the pooled sensitivity of postmenopause and premenopausal/perimenopausal groups were 0.83 and 0.80, respectively. However, the postmenopause group has a higher pooled specificity: 0.68 versus 0.32 compared with premenopausal/perimenopausal women, and a higher corresponding AUC (0.81 versus 0.56).
  
  
  CONCLUSIONS
  TET may be used as a triage test for women with suspected and subclinical CAD. The positive results of TET should be treated with caution because of its higher false-positive, especially for premenopausal/perimenopausal women, and further confirmatory diagnosis is needed. However, patients with negative TET results could be precluded for further evaluation using CAG, and avoid unnecessary risk and economic burden to patients.
authors.affiliation: State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037), China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Sun
authors.affiliation: State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037), China. Electronic address: liwei@mrbc-nccd.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.affiliation: State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037), China.
authors.forename: Lu
authors.initials: L
authors.lastname: Yin
authors.affiliation: State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037), China.
authors.forename: Limei
authors.initials: L
authors.lastname: Wei
authors.affiliation: State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037), China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Wang
mesh_terms: D044466:Asian People; D017023:Coronary Angiography / Q000379:methods / Q000592:standards*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology; D005080:Exercise Test / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D047648:Perimenopause / Q000502:physiology; D017698:Postmenopause / Q000502:physiology; D015203:Reproducibility of Results
keywords: Coronary artery diseases (CAD); Meta-analysis; Perimenopause women; Postmenopausal women; Systematic review; Treadmill exercise tests (TET)