Akil S, Hedén B, Pahlm O, Carlsson M, Arheden H, Engblom H. Gender aspects on exercise-induced ECG changes in relation to scintigraphic evidence of myocardial ischaemia.
Clin Physiol Funct Imaging 2017;
38:798-807. [PMID:
29115010 DOI:
10.1111/cpf.12483]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/11/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND
This retrospective study aimed to determine the diagnostic performance of exercise-induced ST response in relation to findings by myocardial perfusion single photon emission computed tomography (MPS), with focus on gender differences, in patients with suspected or established stable ischemic heart disease.
METHODS
MPS findings of 1 021 patients (518 females) were related to the exercise-induced ST response alone (blinded and unblinded to gender) and ST response together with additional exercise stress test (EST) variables (exercise capacity, blood pressure and heart rate response).
RESULTS
Exercise-induced ischaemia by MPS was found in 9% of females and 23% of males. Diagnostic performance of exercise-induced ST response in relation to MPS findings in females versus males was: sensitivity = 48%,70%; specificity = 67%, 64%; PPV = 13%, 38%; NPV = 93%, 87%. Adding more EST variables to the ST response interpretation yielded in females vs males: sensitivity = 44%, 51%; specificity = 84%, 83%; PPV = 22%, 48% and NPV = 93%, 85%.
CONCLUSIONS
In patients who have performed EST in conjunction with MPS, there is a gender difference in the diagnostic performance of ST response at stress, with a significantly lower PPV in females compared to males. For both genders, specificity can be significantly improved, and a higher PPV can be obtained, while the sensitivity might be compromised by considering more EST variables, in addition to the ST response.
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