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Stress echocardiography in women.

Publication ,  Journal Article
Tong, AT; Douglas, PS
Published in: Cardiol Clin
August 1999

The diagnosis of coronary heart disease in women has been thought to be more difficult than in men, owing to the overall lower prevalence and severity of disease in women, as well as more subtle clinical presentations. Exercise electrocardiography is associated with a high rate of false-positive results. In contrast, exercise and pharmacologic stress echocardiography have been shown to have high sensitivity, specificity, and prognostic value in women, comparable to that obtained in a male population. Although exercise thallium provides high f disease accuracy, due to its cost, availability, and radiation exposure, it may not be the ideal initial test in women. Thus, compared with other modalities, the advantages of stress echocardiography include its lower cost, availability, and high diagnostic accuracy. In the evaluation of women with chest pain, the initial step should involve clinical stratification into low, moderate, or high-probability groups based on symptoms, age, and cardiovascular risk factors. In women with atypical chest pain and a low probability of coronary heart disease, further testing should be avoided because any positive result is likely to be falsely positive. In those women with a moderate likelihood of disease, the most efficient and cost-effective strategy includes stress echocardiography as the initial test. This approach avoids the high rate of false-positive results with subsequent unnecessary angiography generated by exercise electrocardiography, as well as minimalizing false-negative results, which would lead to delays and potential increase in morbidity and mortality from untreated coronary heart disease. The optimal strategy for women at high clinical risk may be either exercise echocardiography or cardiac catheterization as the initial test. Although the diagnosis of CAD in women is different than in men, it is not necessarily more difficult. Astute clinical evaluation, in conjunction with judicious use of diagnostic testing, yields excellent results.

Duke Scholars

Published In

Cardiol Clin

DOI

ISSN

0733-8651

Publication Date

August 1999

Volume

17

Issue

3

Start / End Page

573 / 582

Location

Netherlands

Related Subject Headings

  • Women's Health
  • United States
  • Sensitivity and Specificity
  • Prognosis
  • Male
  • Humans
  • Female
  • Exercise Test
  • Echocardiography
  • Cost-Benefit Analysis
 

Citation

APA
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ICMJE
MLA
NLM
Tong, A. T., & Douglas, P. S. (1999). Stress echocardiography in women. Cardiol Clin, 17(3), 573–582. https://doi.org/10.1016/s0733-8651(05)70097-7
Tong, A. T., and P. S. Douglas. “Stress echocardiography in women.Cardiol Clin 17, no. 3 (August 1999): 573–82. https://doi.org/10.1016/s0733-8651(05)70097-7.
Tong AT, Douglas PS. Stress echocardiography in women. Cardiol Clin. 1999 Aug;17(3):573–82.
Tong, A. T., and P. S. Douglas. “Stress echocardiography in women.Cardiol Clin, vol. 17, no. 3, Aug. 1999, pp. 573–82. Pubmed, doi:10.1016/s0733-8651(05)70097-7.
Tong AT, Douglas PS. Stress echocardiography in women. Cardiol Clin. 1999 Aug;17(3):573–582.
Journal cover image

Published In

Cardiol Clin

DOI

ISSN

0733-8651

Publication Date

August 1999

Volume

17

Issue

3

Start / End Page

573 / 582

Location

Netherlands

Related Subject Headings

  • Women's Health
  • United States
  • Sensitivity and Specificity
  • Prognosis
  • Male
  • Humans
  • Female
  • Exercise Test
  • Echocardiography
  • Cost-Benefit Analysis