What is the role of treadmill stress testing in the diagnosis of coronary artery disease (CAD) in women?

Updated: Nov 21, 2018
  • Author: David Akinpelu, MD, FACP; Chief Editor: Eric H Yang, MD  more...
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The utility of exercise ECG for the diagnosis of CAD in women is limited. Exercise-induced ST depression is less sensitive in women than in men, reflecting a lower prevalence of severe CAD and the inability of many women to exercise to maximum aerobic capacity. Exercise ECG findings are also commonly viewed as less specific in women than in men, though careful review of the published data demonstrates that this finding certainly has not been uniform.

Studies reporting lower specificity in women have cited lower disease prevalence, non-Bayesian factors, and possible hormonal differences. It is important to be cognizant of the decrease in sensitivity that occurs when women do not exercise to maximum aerobic capacity. Patients likely to exercise submaximally should be considered for pharmacologic stress testing. Concern about false-positive ST-segment responses may be addressed through careful assessment of posttest probability and selective use of stress imaging tests before angiography.

Although the optimal strategy for circumventing false-positive test results for the diagnosis of CAD in women remains to be defined, the data are insufficient to justify routine stress imaging tests as the initial test for the diagnosis of CAD in women.

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