Author + information
- Received December 1, 1987
- Revision received March 16, 1988
- Accepted April 6, 1988
- Published online January 1, 1988.
- Michele Masini, MDa,
- Eugenio Picano, MD,
- Fabio Lattanzi, MD,
- Alessandro Distante, MD and
- Antonio L'Abbate, MD, FACC
- ↵aAddress for reprints: Michele Masini, MD, Istituto di Fisiologia Clinica del CNR, Via Savi 8, 56100-Pisa, Italy.
The value of the exercise-electrocardiography test in detecting coronary artery disease in women is limited. Recently, the high dose dipyridamole-echocardiography test (two-dimensional echocardiographic monitoring during intravenous dipyridamole infusion, up to 0.84 mg/kg body weight over 10 min) was proposed as an alternative to exercise testing for the diagnosis of coronary artery disease. To establish the diagnostic usefulness of the exercise-electrocardiography and dipyridamole-echocardiography tests in this disease, the two tests were performed-on different days and in random order-in 83 consecutive women evaluated for a chest pain syndrome. All 83 women had taken no medications for >48h, and 15 had had a previous myocardial infarction.
Positivity of the dipyridamole-echocardiography test was based on detection of a transient asynergy of contraction that was absent or of lesser degree at rest; the exercise-electrocardiography test (by upright cycloergometer) was considered positive when the ST segment was shifted >0.1 mV 0.08 s after the J point. Coronary angiography showed significant coronary artery disease (>70% luminal reduction of at least one major coronary vessel) in 39 women. No significant complications occurred in any patient during either test.
Sensitivity and predictive value of a negative test were similar for the dipyridamole-echocardiography and the exercise-electrocardiography test (79 versus 72% and 84 versus 68%, respectively, whereas the dipyridamoleechocardiography test had greater specificity (93 versus 52%, p < 0.001), accuracy (87 versus 62%, p < 0.001) and a higher predictive value of a positive test (91 versus 57%, p < 0.01).
Thus, the dipyridamole-echocardiography test appears to be of greater diagnostic value than does the exerciseelectrocardiography test for noninvasive detection of coronary artery disease in women.
* This study was presented in part at the 37th Annual Meeting of the American College of Cardiology, Atlanta, Georgia, March 1988.
- Received December 1, 1987.
- Revision received March 16, 1988.
- Accepted April 6, 1988.
- American College of Cardiology