Diagnosis of silent myocardial ischemia in women

The diagnosis of silent ischaemic heart disease may be important in men as well as in women. However, diagnosing women by exercise ECG is limited due to the higher rate of false positive results. For improving diagnostic validity the following investigations were done. In 310 women, aged 41-63 years (mean age 47 years', revealing 'pathological' exercise ECG, further testing was performed using nitroglycerin (NTG 0.8 mg). As a reference method, pulmonary artery (PA) pressure measurement was used. As a result of NTG testing, two groups could be separated: (a) those in whom ST segment depression remained constant (N = 217, NTG negatives = 70%). Since the end-diastolic PA pressure was found normal, these results were interpreted to be false-positive. (b) NTG effected a reduction or normalization of exercise induced ST segment changes (N = 93, NTG positives = 30%). There was a correspondence with exercise inducible end-diastolic PA pressure decrease. Consequently, true positives were assumed. Analysis of angina pectoris history indicated typical chest pain in 2% of NTG negatives only, but in 16% of NTG positives. In agreement with this during exercise, angina was reported by NTG negatives in 3% of cases and by NTG positive in 17%. The rest of this group (83%) is considered having exercise induceable silent myocardial ischaemia. When checking-up after five years, exercised-induced angina could be found in 4% of NTG negatives again, but in 36% of NTG positives. It was concluded that exercise testing by additionally using nitroglycerin is a rather important approach for diagnosing myocardial ischaemia in women.(ABSTRACT TRUNCATED AT 250 WORDS)