Abstract
BackgroundMultiple studies have shown that the exercise electrocardiogram (ECG) is less accurate for predicting ischemia, especially in women, and there is additional evidence to suggest that heart size may affect its diagnostic accuracy.HypothesisThe purpose of this investigation was to assess the diagnostic accuracy of the exercise ECG based on heart size.MethodsWe evaluated 1,011 consecutive patients who were referred for an exercise nuclear stress test. Patients were divided into two groups: small heart size defined as left ventricular end diastolic volume (LVEDV) <65 mL (Group A) and normal heart size defined as LVEDV ≥65 mL (Group B) and associations between ECG outcome (false positive vs. no false positive) and heart size (small vs. normal) were analyzed using the Chi square test for independence, with a Yates continuity correction. LVEDV calculations were performed via a computer-processing algorithm. SPECT myocardial perfusion imaging was used as the gold standard for the presence of coronary artery disease (CAD).ResultsSmall heart size was found in 142 patients, 123 female and 19 male patients. There was a significant association between ECG outcome and heart size (χ2 = 4.7, p = 0.03), where smaller hearts were associated with a significantly greater number of false positives.ConclusionsThis study suggests a possible explanation for the poor diagnostic accuracy of exercise stress testing, especially in women, as the overwhelming majority of patients with small heart size were women.
Highlights
Cardiovascular disease is the leading cause of death in the United States claiming the lives of over 230,000 individuals each year [1]
This study suggests a possible explanation for the poor diagnostic accuracy of exercise stress testing, especially in women, as the overwhelming majority of patients with small heart size were women
Diagnostic accuracy in women varies depending on the test administered [4,5,6]
Summary
Cardiovascular disease is the leading cause of death in the United States claiming the lives of over 230,000 individuals each year [1]. The mortality from cardiovascular disease has recently been decreasing in men, it has been increasing for women [1]. Numerous studies have indicated that noninvasive cardiac stress tests have a lower diagnostic accuracy in women [2,3]. Diagnostic accuracy in women varies depending on the test administered (i.e. stress echocardiography, stress myocardial perfusion imaging, pharmacologic or exercise electrocardiogram) [4,5,6]. Multiple studies have shown that the exercise electrocardiogram (ECG) is less accurate for predicting ischemia, especially in women, and there is additional evidence to suggest that heart size may affect its diagnostic accuracy. Hypothesis: The purpose of this investigation was to assess the diagnostic accuracy of the exercise ECG based on heart size
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
