CAD Diagnostics in Premenopausal Women: The Influence of Menstrual Cycle
CAD Diagnostics in Premenopausal Women: The Influence of Menstrual Cycle
Background: The aim was to assess the influence of menstrual cycle on results of exercise echocardiography and electrocardiography.
Methods: Premenopausal women (n = 28) with regular monthly menses, presented typical angina, positive electrocardiogram (ECG) exercise stress test, and normal coronary angiogram were recruited. Exercise supine bicycle echocardiography with simultaneous recording of 12-lead ECG was performed once a week for 4 consecutive weeks. Occurrence of angina, time to angina, time to significant ST deviation, and segmental myocardial contractility were analyzed. Blood samples were drawn to estimate follicle-stimulating hormone, luteinizing hormone, β-estradiol, progesterone concentration and confirm the position in menstrual cycle. In correlation analysis, linear and logistic regression were used as appropriate. Qualitative variables were categorized into quartiles in logistic regression analysis.
Results: Exercise ST depression was more frequently observed in both luteal phases (early luteal 78%, late luteal 86%) compared to the late follicular phase (50%, P < .05). Time to ST depression was significantly longer in late follicular phase compared to other phases. The rate of segmental exercise left ventricular hypokinesis was low and not significantly related to menstrual cycle. Using linear regression, significant positive correlation was found between estradiol-progesterone ratio and time to ST depression. Using multiple logistic regression, we confirmed that progesterone level is independent factor influencing the presence of ST depression.
Conclusion: In women with typical angina and normal coronary angiogram, the position in menstrual cycle influences the ST depression but not myocardial contractility during exercise echocardiography.
Women with typical chest pain suggestive of myocardial ischemia represent a diagnostic challenge. According to American College of Cardiology-National Cardiovascular Data Registry, half of all women with chest pain undergoing coronary angiography do not have coronary artery disease (CAD). Premenopausal women are at relatively low risk of CAD. Pretest likelihood of CAD in women aged 40 to 49 years with typical chest pain is 55%. The rate of false-positive electrocardiographic (ECG) stress test results in women with angina is high. In a published meta-analysis that included 19 exercise ECG studies with 3,721 women, specificity was 70%. On the basis of the aggregate data available in studies of nearly 1,000 women with suspected CAD, stress echocardiography has demonstrated better diagnostic accuracy for detecting or ruling out significant CAD, with mean sensitivity of 81% (89% in women with multivessel disease), specificity of 86%, and overall accuracy of 84%. There is a lack of information on the relation between the menstrual cycle and results of ECG and echocardiographic exercise stress tests in premenopausal women with angina and without significant stenosis in coronary arteries.
Background: The aim was to assess the influence of menstrual cycle on results of exercise echocardiography and electrocardiography.
Methods: Premenopausal women (n = 28) with regular monthly menses, presented typical angina, positive electrocardiogram (ECG) exercise stress test, and normal coronary angiogram were recruited. Exercise supine bicycle echocardiography with simultaneous recording of 12-lead ECG was performed once a week for 4 consecutive weeks. Occurrence of angina, time to angina, time to significant ST deviation, and segmental myocardial contractility were analyzed. Blood samples were drawn to estimate follicle-stimulating hormone, luteinizing hormone, β-estradiol, progesterone concentration and confirm the position in menstrual cycle. In correlation analysis, linear and logistic regression were used as appropriate. Qualitative variables were categorized into quartiles in logistic regression analysis.
Results: Exercise ST depression was more frequently observed in both luteal phases (early luteal 78%, late luteal 86%) compared to the late follicular phase (50%, P < .05). Time to ST depression was significantly longer in late follicular phase compared to other phases. The rate of segmental exercise left ventricular hypokinesis was low and not significantly related to menstrual cycle. Using linear regression, significant positive correlation was found between estradiol-progesterone ratio and time to ST depression. Using multiple logistic regression, we confirmed that progesterone level is independent factor influencing the presence of ST depression.
Conclusion: In women with typical angina and normal coronary angiogram, the position in menstrual cycle influences the ST depression but not myocardial contractility during exercise echocardiography.
Women with typical chest pain suggestive of myocardial ischemia represent a diagnostic challenge. According to American College of Cardiology-National Cardiovascular Data Registry, half of all women with chest pain undergoing coronary angiography do not have coronary artery disease (CAD). Premenopausal women are at relatively low risk of CAD. Pretest likelihood of CAD in women aged 40 to 49 years with typical chest pain is 55%. The rate of false-positive electrocardiographic (ECG) stress test results in women with angina is high. In a published meta-analysis that included 19 exercise ECG studies with 3,721 women, specificity was 70%. On the basis of the aggregate data available in studies of nearly 1,000 women with suspected CAD, stress echocardiography has demonstrated better diagnostic accuracy for detecting or ruling out significant CAD, with mean sensitivity of 81% (89% in women with multivessel disease), specificity of 86%, and overall accuracy of 84%. There is a lack of information on the relation between the menstrual cycle and results of ECG and echocardiographic exercise stress tests in premenopausal women with angina and without significant stenosis in coronary arteries.
