Diagnostic value of history and maximal exercise electrocardiography in men and women suspected of coronary heart disease

Abstract

Coronary arteriographic data have been compared in 278 patients (231 males and 47 females) with the ECG response to a maximal exercise test and with the history (myocardial infarction - MI, typical or atypical angina pectoris - AP). The sensitivity and specificity of exercise ECG were similar in males and females. False negative ECG responses were frequent in males (40%) and false positive ECG responses were frequent in females (38%). This difference between sexes was essentially due in our patients to the higher prevalence of CHD in males (80%) than in females (43%). In the absence of a previous MI, a history of typical AP was associated with coronary heart disease (CHD) in 94% of males and 62% of females. Atypical AP was rarely associated with CHD (18% in males; 11% in females). When typical AP was associated with an abnormal exercise ECG, CHD was highly probable in males (98%) and present in 75% of females. In presence of atypical AP with a normal exercise ECG, CHD was unlikely in males (11%) and in females (8%). The authors conclude that exercise ECG has limited value for the diagnosis of CHD. In men with typical AP, exercise ECG often confirms the diagnosis but a negative ECG exercise does not rule out CHD because of the high incidence of fales negative responses. In males and females with atypical AP, an abnormal response to exercise is difficult to interpret owing to a high incidence of false positive responses.