Maximum treadmill exercise testing in females yielded 71% sensitivity and 78% specificity for coronary artery disease, with false positives largely driven by baseline ECG abnormalities and drug therapy.
Observational (n=98)
Does maximum treadmill exercise electrocardiography accurately detect coronary artery disease in female patients?
Maximum treadmill exercise ECG is a valid diagnostic tool in females, performing similarly to males when confounding factors like resting ECG abnormalities and certain medications are excluded.
Effect estimate: Sensitivity 71%, Specificity 78%
Exercise testing has become standardized for the diagnostic and functional evaluation of male patients but little data is available regarding its specificity and sensitivity in the female. Therefore, maximum treadmill exercise (Bruce protocol) was performed on 98 consecutive females and compared to coronary arteriography. Using 50% obstruction as indicating coronary artery disease and 1 mm ST-segment depression (horizontal or downsloping) as positive for ischemia, 24 patients had coronary artery disease with seven false-negative results (sensitivity = 71%) and 74 patients had no coronary artery disease with 16 false-positive responses (specificity = 78%). Five of seven false-negative tests were in patients with single-vessel disease. Eleven of 16 false-positive responses were in patients on digitalis, diazepam, or methyldopa. In 39 patients on no drug therapy except for nitroglycerin there were no false negatives and only four false-positive tests. There were no false negatives and only two false-positive tests in 34 patients with normal resting electrocardiograms. Only one of 18 patients with both normal resting electrocardiograms and on no drug therapy had a false-positive test result. Eleven false-positive and seven false-negative results occurred in 40 patients with both an abnormal resting electrocardiogram and associated drug therapy. The exercise electrocardiographic response in female patients is similar to the male when patients with resting electrocardiographic abnormalities and concomitant drug therapy are eliminated.
Linhart et al. (Sun,) conducted a observational in Coronary artery disease (n=98). Maximum treadmill exercise (Bruce protocol) vs. Coronary arteriography was evaluated on Diagnostic accuracy for coronary artery disease (≥50% obstruction) (Sensitivity 71%, Specificity 78%). Maximum treadmill exercise testing in females yielded 71% sensitivity and 78% specificity for coronary artery disease, with false positives largely driven by baseline ECG abnormalities and drug therapy.