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European Heart Journal 1989 10(6):543-550;
Copyright © 1989 by the European Society of Cardiology.
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© 1989 The European Society of Cardiology

Diagnostic merits of exercise testing in females

J.W. DECKERS, B.J. RENSING, M.L. SIMOONS and J.R.T.C. ROELANDT

Thoraxcenter, Department of Cardiology, University Hospital Rotterdam, Dijkzigt and Erasmus University Rotterdam, The Netherlands

Received 12 July 1988; accepted 25 November 1988.

Address for reprints: Jaap W. Deckers M.D., Thoraxcenter, Bd 381, Univerrity Hospital Rotterdam 'Dijkzigt', Dr. Mokwaterplein 40, 3015 GD Rotterdam, The Netherlands.

Abstract

The diagnostic accuracy of conventional exercise electrocardiography was compared with exercise algorithms specifically aimed at application in females, with R wave and heart rate adjusted ST-segment changes, and with discriminant analysis. A symptom-limited bicycle exercise test was performed by 189 females without previous infarction with a normal electrocardiogram (ECG) at rest. Frank lead ECG was computer processed. ST-segment amplitudes in lead X were superior to measurements in lead Y, but their sensitivity amounted only to 50% at a specificity of 90%. Correction for R wave amplitude marginally increased sensitivity. It was confirmed that leads with inferiorly directed vectors such as standard leads II, III, a VF or Frank lead Y should not be used for diagnostic purposes in females. Exercise-induced increases in R-wave amplitude of at least 01 mV occurred in only 8% of females with coronary disease. Previously described discriminant function using attained heart rate, ST-segment depression and a sex-dependent ST segment correction factor yielded a sensitivity of 60% at a specificity of 90%. Sensitivities of heart rate adjusted ST-segment changes and of a previously proposed discriminant function were greater than 70% at a specificity of 90%. It is concluded that the diagnostic yield of exercise testing in females can be improved by use of more sophisticated electrocardio-graphic and exercise variables.

Key Words: Diagnosis • coronary artery disease • exercise testing • females


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