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False-positive stress testing: Does endothelial vascular dysfunction contribute to ST-segment depression in women? A

Shilpa Sharma1, Puja K Mehta2, Reza Arsanjani1

  • 1Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California.

Clinical Cardiology
|June 20, 2018
PubMed

Insights

Exercise-induced ST-segment depression is common in asymptomatic women, but peripheral vascular endothelial dysfunction does not predict these results. Further research is needed for accurate ischemic heart disease diagnosis in women.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Diagnostic Testing

Background:

  • The diagnostic utility of exercise-induced ST-segment depression for ischemic heart disease (IHD) in women remains uncertain.
  • IHD pathophysiology in women may involve coronary vascular dysfunction, potentially leading to false positive exercise electrocardiogram (Ex-ECG) results.

Purpose of the Study:

  • To investigate the hypothesis that coronary vascular dysfunction contributes to false positive Ex-ECG results in women.
  • To evaluate the relationship between peripheral vascular endothelial function and Ex-ECG findings in asymptomatic women.

Main Methods:

  • A pilot study involving 29 asymptomatic women without cardiac risk factors.
  • Maximal Bruce protocol exercise treadmill testing and peripheral endothelial function assessment using peripheral arterial tonometry to measure reactive hyperemia index (RHI).
  • Logistic regression and t tests were used to analyze the relationship between RHI and ST-segment depression.

Main Results:

  • A high prevalence of positive Ex-ECG (62%) was observed in the study population.
  • Peripheral endothelial function (RHI) was not significantly different between women with and without ST-segment depression.
  • Reactive hyperemia index (RHI) did not predict exercise-induced ST-segment depression.

Conclusions:

  • Exercise-induced ST-segment depression is prevalent in asymptomatic, middle-aged, overweight women.
  • Peripheral vascular endothelial dysfunction does not appear to predict Ex-ECG ST-segment depression in this population.
  • Further investigation is required to clarify the roles of vascular endothelial testing and Ex-ECG in IHD diagnosis and management for women.
Abstract

Keywords:
Exercise ElectrocardiographyReactive Hyperemia IndexST DepressionWomen

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