Detection of exercise-induced myocardial ischemia from symptomatology experienced during testing in men and women

• Published in: Canadian journal of cardiology 2006-04, Vol.22 (5), p.411-417
• Main Authors: D’Antono, Bianca, Dupuis, Gilles, Fortin, Christophe, Arsenault, André, Burelle, Denis
• Format: Article
• Language: English
• Subjects: Angina; Chest Pain - etiology; Clinical Studies; Coronary disease; Exercise Test; Female; Humans; Hypesthesia - etiology; Imaging; Ischemia; Logistic Models; Magnetic Resonance Angiography; Male; Middle Aged; Myocardial Ischemia - complications; Myocardial Ischemia - diagnosis; Prospective Studies; Risk Factors; Sex; Sex Factors; Sweating
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/S0828-282X(06)70927-8

To examine the capacity of angina and related symptoms experienced during exercise-stress testing to detect the presence of ischemia, controlling for other clinical factors. The authors undertook a prospective study of 482 women and 425 men (mean age 58 years) undergoing exercise stress testing with myocardial perfusion imaging. One hundred forty-six women and 127 men reported chest pain, and of these, 25% of women and 66% of men had myocardial perfusion imaging evidence of ischemia during testing. The present article focuses on patients with chest pain during testing. Outcome measures included chest pain localization, extension, intensity and quality, as well as the presence of various nonpain-related symptoms. Backward logistical regression analyses were performed separately on men and women who had experienced chest pain during testing. Men who described their chest pain as ‘heavy’ were 4.6 times more likely to experience ischemia during testing (P=0.039) compared with other men, but this pain descriptor only slightly improved accuracy of prediction beyond that provided by control variables. In women, several symptoms added to the sensitivity of the prediction, such as a numb feeling in the face or neck region (OR 4.5; P=0.048), a numb feeling in the chest area (OR 14.6; P=0.003), muscle tension (OR 5.2; P=0.013), and chest pain that was described as hot or burning (OR 4.3; P=0.014). A more refined evaluation of symptoms experienced during testing was particularly helpful in improving detection of ischemia in women, but not in men. Attention to these symptoms may favour timely diagnosis of myocardial perfusion defects in women. Examiner la capacité de l’angine et des symptômes connexes ressentis pendant une épreuve à l’effort à déceler la présence d’ischémie, afin de contrôler d’autres facteurs cliniques. Les auteurs ont entrepris une étude prospective auprès de 482 femmes et de 425 hommes (âge moyen de 58 ans) subissant une épreuve à l’effort accompagnée d’une imagerie de perfusion myocardique. Cent quarante-six femmes et 127 hommes ont déclaré ressentir des douleurs thoraciques. De ce nombre, 25% des femmes et 66% des hommes présentaient des signes d’ischémie à l’imagerie de perfusion myocardique pendant l’épreuve. Le manuscrit porte sur les patients ressentant des douleurs thoraciques pendant l’épreuve à l’effort. Les mesures d’issues incluent le foyer, l’étendue, l’intensité et la qualité des douleurs thoraciques, de même que la présence de divers s