CLINICAL STUDIES
Value of exercise treadmill testing in women
Karen P. Alexander, MD*,
Leslee J. Shaw, PhDa,
Elizabeth R. DeLong, PhD ,
Daniel B. Mark, MD, MPH, FACC* and
Eric D. Peterson, MD, MPH*
a Outcomes Research and Assessment Group, Duke Clinical Research Institute, the Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
* Department of Medicine, and the Division of Biometry, Duke University Medical Center, Durham, North Carolina, USA
Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina, USA
Manuscript received May 13, 1998;
revised manuscript received July 7, 1998,
accepted July 24, 1998.
Address for correspondence: Dr. Karen P. Alexander, Box 3411, Duke University Medical Center, Durham, North Carolina 27710
alexa019{at}mc.duke.edu
Objectives. We sought to determine the ability of a treadmill score to provide accurate diagnostic and prognostic risk estimates in women.
Background. Treadmill testing has been reported to have a lower accuracy for diagnosis of chest pain in women. The diagnostic and prognostic value of the Duke Treadmill Score (DTS) in women is unknown.
Methods. We determined the diagnostic and prognostic value of the DTS in 976 women and 2,249 men who underwent both treadmill testing and cardiac catheterization in a single institution from 1984 to 1994.
Results. Women and men differed significantly in DTS (1.6 vs. –0.3, p < 0.0001), disease prevalence (32% vs. 72% significant coronary artery disease [CAD], p < 0.001), and 2-year mortality (1.9% vs. 4.9%, p < 0.0001). The DTS provided information beyond clinical predictors of both coronary disease and survival in women and men. Although overall women had better survival, the DTS performed equally well in stratifying both genders into prognostic categories. The DTS actually performed better in women than in men for excluding disease, with fewer low risk women having any significant coronary disease ( 1 vessel with 75% stenosis) (20% vs. 47%, p < 0.001), or severe disease (3-vessel disease or 75% left main stenosis) (3.5% vs. 11.4%, p < 0.001).
Conclusions. By combining several aspects of treadmill testing, the DTS effectively stratifies women into diagnostic and prognostic risk categories.
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Abbreviations and Acronyms
| | ACC | = American College of Cardiology | | AHA | = American Heart Association | | AHCPR | = Agency for Health Care Policy and Research | | DTS | = Duke Treadmill Score | | ROC | = receiver operating characteristic |
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