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Erschienen in: Clinical Research in Cardiology 3/2015

01.03.2015 | Original Paper

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

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

Erschienen in: Clinical Research in Cardiology | Ausgabe 3/2015

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Abstract

Background

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).

Methods

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.

Results

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.

Conclusions

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.
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Metadaten
Titel
Detection of coronary artery disease in postmenopausal women: the significance of integrated stress imaging tests in a 4-year prognostic study
verfasst von
Michael Becker
Anne Hundemer
Christian Zwicker
Ertunc Altiok
Thomas Krohn
Felix M. Mottaghy
Christina Lente
Malte Kelm
Nikolaus Marx
Rainer Hoffmann
Publikationsdatum
01.03.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Clinical Research in Cardiology / Ausgabe 3/2015
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692
DOI
https://doi.org/10.1007/s00392-014-0780-5

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