How to improve noninvasive coronary artery disease diagnostics in premenopausal women?: The influence of menstrual cycle on ST depression, left ventricle contractility, and chest pain observed during exercise echocardiography in women with angina and normal coronary angiogram

Abstract

The aim was to assess the influence of menstrual cycle on results of exercise echocardiography and electrocardiography. Premenopausal women (n=28) with regular monthly menses, presented typical angina, positive electrocardiogram (ECG) exercise stress test, and normal coronary angiogram were recruited. Exercise supine bicycle echocardiography with simultaneous recording of 12-lead ECG was performed once a week for 4 consecutive weeks. Occurrence of angina, time to angina, time to significant ST deviation, and segmental myocardial contractility were analyzed. Blood samples were drawn to estimate follicle-stimulating hormone, luteinizing hormone, beta-estradiol, progesterone concentration and confirm the position in menstrual cycle. In correlation analysis, linear and logistic regression were used as appropriate. Qualitative variables were categorized into quartiles in logistic regression analysis. Exercise ST depression was more frequently observed in both luteal phases (early luteal 78%, late luteal 86%) compared to the late follicular phase (50%, P<.05). Time to ST depression was significantly longer in late follicular phase compared to other phases. The rate of segmental exercise left ventricular hypokinesis was low and not significantly related to menstrual cycle. Using linear regression, significant positive correlation was found between estradiol-progesterone ratio and time to ST depression. Using multiple logistic regression, we confirmed that progesterone level is independent factor influencing the presence of ST depression. In women with typical angina and normal coronary angiogram, the position in menstrual cycle influences the ST depression but not myocardial contractility during exercise echocardiography.