Maximum treadmill exercise electrocardiography in female patients

Abstract

Exercise testing has become standardized for the diagnostic and functional evaluation of male patients, but little data is available regarding its specificity and sensitivity in the female. Therefore, maximum treadmill exercise (Bruse protocol) was given to 98 consecutive females, and compared with coronary arteriography. Using 50% obstruction as indicating coronary artery disease and 1 mm ST segment depression (horizontal or downsloping) as positive for ischemia, 24 patients had coronary artery disease with 7 false negative results (sensitivity = 71%), and 74 patients had no coronary artery disease with 16 false positive responses (specificity = 78%). 5 of 7 false negative tests were in patients with single vessel disease. 11 of 16 false positive responses were in patients on digitalis, diazepam, or methyldopa. In 39 patients on no drug therapy except for nitroglycerin, there were no false negatives and only 4 false positive tests. There were no false negatives and only 2 false positive tests in 34 patients with normal resting electrocardiograms. Only one of 18 patients with both normal resting electrocardiograms and on no drug therapy had a false positive test result. 11 false positive and 7 false negative results occurred in 40 patients with both an abnormal resting electrocardiogram and associated drug therapy. The exercise electrocardiographic response in female patients is similar to the male response when patients with resting electrocardiographic abnormalities and concomitant drug therapy are eliminated.