Clinical investigations: imaging and diagnostic testingValidation of the accuracy of pretest and exercise test scores in women with a low prevalence of coronary disease: the NHLBI-sponsored Women's Ischemia Syndrome Evaluation (WISE) study☆
Section snippets
Patient population
The WISE study is a National Heart, Lung, and Blood Institute sponsored 4-center study that aims to improve the diagnostic reliability of cardiovascular testing in the evaluation of ischemic heart disease in women. Women with chest pain symptoms or suspected ischemia undergo an initial evaluation that includes the collection of demographic, medical history, and risk factor data. The complete study design and methodology of the WISE study are described elsewhere.5
We excluded from this analysis
Patient populations
Table Iincludes a summary of clinical and exercise test characteristics and the 3 scores considered. In the pretest score group, coronary disease was found in 148 of 563 women or 26.2%. In the new exercise score group, coronary disease was found in 50 of 189 women or 26.5%. Prevalences within predetermined probability subgroups (Figure 1) for all 3 scores are displayed on Table II. With the exception of the Duke score, stratification by both coronary disease presence and multivessel disease on
Discussion
Exercise ST segment responses in women are associated with both lower sensitivity and specificity rates than in men,15 even when post-test referral bias is considered.16 Despite these differences in ST segment response accuracy, incorporation of ST responses into multivariable models with clinical and other exercise test variables leads to similar accuracy in men and women.7, 14 Previous validation of both the pretest and exercise scores3, 4 demonstrated qualitatively similar results to this
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Electrocardiographic exercise stress testing: An update beyond the ST segment
2007, International Journal of CardiologyCitation Excerpt :Is clinically relevant, and may prognosticate in cases where the patients test is borderline by conventional criteria; Is validated in men and women; though good at excluding significant disease in women if normal, it may not stratify moderate- and high-risk women as well as men [108,109]; Performs well against other more cumbersome scores [110];
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2018, Journal of the American Heart AssociationFemale gender and cardiovascular disease
2016, British Journal of Hospital Medicine
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Supported by NHLBI contracts (N01-HV-68161, N01-HV-68162, N01-HV-68163, N01-HV-68164 and U01-HL64829-01, U01-HL64914-01, U01-HL64924-01) and grants from the Gustavus and Louis Pfieffer Research Foundation, Danville, NJ, the Women's Guild of Cedars-Sinai Medical Center, Los Angeles, Calif, the Ladies Hospital Aid Society of Western Pennsylvania, Pittsburgh, Pa, and QMED Inc, Laurence Harbor, NJ.