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Related Experiment Videos

Women with chest pain: is exercise testing worthwhile?

N Curzen1, D Patel, D Clarke

  • 1Department of Cardiology, Royal Brompton Hospital, London.

Heart (British Cardiac Society)
|August 1, 1996
PubMed
Summary

The exercise tolerance test (ETT) is a misleading predictor for coronary artery disease in women with chest pain, especially older women with multiple risk factors. Age and risk factors can help identify intermediate-risk patients for whom ETT has diagnostic utility.

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Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Preventive Medicine

Background:

  • Chest pain is a common symptom in women, necessitating accurate diagnostic tools.
  • The exercise tolerance test (ETT) is frequently used to evaluate for coronary artery disease (CAD) in women presenting with chest pain.

Purpose of the Study:

  • To assess the diagnostic accuracy of the exercise tolerance test (ETT) in women experiencing chest pain.
  • To determine the predictive value of ETT results based on patient demographics and risk factors.

Main Methods:

  • A prospective study was conducted on women presenting with chest pain between 1987 and 1993.
  • Participants underwent both an exercise tolerance test (ETT) and coronary angiography.
  • Exclusion criteria included inability to perform ETT or presence of EKG abnormalities.

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Main Results:

  • The overall sensitivity of ETT was 68% and specificity was 61%, with a 36% misclassification rate.
  • Negative predictive value was higher in younger women (<52 years) and those with fewer risk factors.
  • Older women (> or = 52 years) with three or more risk factors had a very low negative predictive value (0.25).

Conclusions:

  • Exercise tolerance testing (ETT) can be a misleading predictor of coronary artery disease in women with chest pain.
  • A negative ETT in older women with multiple risk factors is particularly unreliable.
  • Incorporating age and risk factors improves the identification of intermediate-risk patients where ETT has the most diagnostic utility.