October 21, 2011
Jennifer Mieres, MD
Heart disease due to coronary artery disease is the leading cause of death of women in the United States. Women with heart disease are more likely than men to have more complications and a higher death rate. So early, accurate diagnosis is critical to prevent death from heart attack.
Exercise testing remains the most widely accessible and relatively inexpensive method for initial evaluation of suspected coronary disease and for assessment of its severity. Despite its commonplace use, there are reports of limited accuracy in diagnosing heart disease in at-risk women. So should women take the plain treadmill exercise stress test or is there a benefit to the more costly test of exercise testing combined with cardiac imaging--that is, exercise myocardial perfusion imaging, also known as a nuclear stress test?
During the What Is the Optimal Method for Ischemia Evaluation in Women (WOMEN) trial, my colleagues and I compared the plain exercise treadmill stress test to the nuclear stress test to evaluate 800 women with symptoms suggestive of heart disease who could exercise. All women could walk on the treadmill for at least six minutes. Half had only the plain exercise treadmill stress test and the other half were evaluated with exercise stress testing combined with myocardial perfusion imaging.
The women were followed for two years and evaluated for heart attacks, continued chest pain and cardiac death. Trial results, published in the American Heart Association journal Circulation, showed that an initial evaluation using only the exercise stress test provided two-year outcomes similar to those women who underwent the exercise nuclear stress test.
The bottom line: The plain exercise treadmill stress test should be the first test of choice for women with complaints suggestive of heart disease who can exercise for at least six minutes on a treadmill. Cardiac imaging combined with exercise treadmill or chemical stress is recommended to evaluate women with known heart disease, those with diabetes and those incapable of a full level of exercise.