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1、DifferencesinElectrocardiographicResponseToExerciseofWomenandMen:ANon-BayesianFactorSTEPHENM.BAROLSKY,M.D.,CHARLESA.GILBERT,M.D.,AZHARFARUQUI,M.D.,DONALD0.NUTTER,M.D.,ANDROBERTC.SCHLANT,M.D.SUMMARYWeevaluatedtheabilityofST-segmentanalysisduringsubmaximalexercisetolerancetesting(85%predictedag
2、e-adjustedheartrate)todiagnosethepresenceofsignificantcoronaryarterystenosis(275%crosssectionalareanarrowing)inagroupof85menand92womenwithchestpainsyndromesandnopreviouslydocumentedmyocardialinfarctions.Diseaseprevalencebyselectivecoronaryangiographywas36%formenand33%forwomen(NS).Predictiveva
3、lueofapositiveexercisetest(PV(+ET))asdefinedby1mmST-segmentdepression0.08secondaftertheJpointwassignificantlyhigherformenthanforwomen(77%vs47%,p<0.05).Predictivevalueofanegativetest(PV(-ET))wasnotsignificantlydifferentformen(81%)andwomen(78%).Analysisofthe66menand66womennottakingdigitalisprep
4、arationsagainshowedthatPV(+ET)wassignificantlyhigherformenthanforwomen(90%vs45%,p<0.01).Multivariateanalysisshowedthatpatientswithangiographicallysignificantcoronarydiseasehadsignificantlylowerattainedheartratesandshorterexercisedurationthanthosewithoutsignificantstenosis,independentofST-segm
5、entresponses.AdiscriminantfunctionusingST-segmentresponse,attainedheartrateandasex-dependentST-segmentresponsefactorwasdeveloped.Durationofexercisewasnotanindependentpredictorbyouranalysis.ThisfunctionimprovedthePV(+ET)andPV(-ET)forthetotalgroupandforthewomen;formen,thePV(-ET)improved,whileth
6、ePV(+ET)fellslightly.Thisfunctionhasnotyetbeenusedprospectively.Inpatientswithchestpainandnopreviouslydocumentedmyocardialinfarction,menhaveasignificantlyhigherPV(+ET)thanwomen,whichcannotbeaccountedforsimplybyadifferenceindiseaseprevalence(i.e.,Bayes'theorem).EXERCISETESTINGhasbeenacommonlyu
7、sedHospitalfrom1971-1977werereviewed,andallDownloadedfromhttp://ahajournals.orgbyonAugust6,2018toolfortheevaluationofcardiacstatusforover20patientsevaluatedforchestpainwhohadbothcor-years.Despiteitsextensiveuseasascreeningtestforonaryangiogra
