Detection of coronary artery disease in postmenopausal women: the significance of integrated stress imaging tests in a 4-year prognostic study

Michael Becker*, Anne Hundemer, Christian Zwicker, Ertunc Altiok, Thomas Krohn, Felix M. Mottaghy, Christina Lente, Malte Kelm, Nikolaus Marx, Rainer Hoffmann

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

6 Citations (Web of Science)

Abstract

The present prospective study investigated whether a combined approach integrating two different stress imaging modalities may improve the diagnostic accuracy and prognostic impact of non-invasive coronary artery disease (CAD) tests in postmenopausal women. In women non-invasive tests for detecting CAD are less accurate than in men, leading to a high proportion of unnecessary coronary angiographies (CAs).424 consecutive postmenopausal women (mean 61?7?years, mean Reynolds Risk Score 13?3?%) with symptoms suggestive of CAD were prospectively included and followed up for 4?1?years. Each patient underwent CA, stress cardiovascular magnetic resonance (CMR) by adenosine, dobutamine stress echocardiography (DSE) and single-photon emission computed tomography (SPECT) within 7?3?days.Anatomically obstructive coronary artery disease (?50?% diameter stenosis) was present in 157 women (37?%). The combination of two stress imaging modalities significantly increased the positive predictive values (PPV) to 90?3, 88?3 and 87?2?% for CMR/DSE, DSE/SPECT and CMR/SPECT, respectively. For patients with negative combined test results, the survival analysis showed a 4-year cumulative event-free survival rate of 96-97?% for all combinations. This new approach is cost effective due to the resulting reduction in unnecessary CAs (with potential side effects and corresponding therapies) as well as reducing hospitalization time.In symptomatic postmenopausal women, combination of two negative stress imaging results significantly increases the PPV for detection of CAD and excludes future cardiovascular events with high accuracy. This approach may be applied to improve the prognostic precision of non-invasive CAD tests and to avoid unnecessary CAs.
Original languageEnglish
Pages (from-to)258-271
JournalClinical research in cardiology
Volume104
Issue number3
DOIs
Publication statusPublished - Mar 2015

Keywords

  • Cardiovascular magnetic resonance
  • Coronary artery disease
  • Echocardiography
  • Postmenopausal women
  • SPECT
  • Stress testing

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