Ecostress em mulheres

Exercise Stress Testing in Women

Going Back to the Basics

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Both exercise stress echocardiography and SPECT techniques have limitations that are specific to women and must be taken into consideration. In exercise SPECT imaging, a false-positive test result can occur because of soft tissue attenuation due to either breast tissue or body habitus. Other gender differences in exercise SPECT may be explained by reduced left ventricular cavity size and smaller coronary arteries in women. Stress echocardiography may be limited by the variability in acoustic windows and the ability to capture images at the point of maximal stress. Despite these limitations, both the diagnostic accuracy and prognostic value of stress SPECT and stress echocardiography exceed those of exercise ECG alone, with no significant differences between men and women.
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Diagnostic Value
Exercise stress echocardiography has a higher specificity and sensitivity than exercise ECG alone, increasing the specificity and sensitivity to 81% to 86% and 80% to 88%, respectively, for diagnosis of obstructive coronary disease in symptomatic women.
There has been no direct comparison of the diagnostic ability of exercise SPECT and exercise echocardiography. In a systematic review of the literature of exercise testing with imaging that included women, the results of 10 studies in which SPECT was used and 4 studies in which echocardiography was used were combined. There was no difference between exercise SPECT and exercise echocardiography in the sensitivity (77% and 81%, respectively) and specificity (63% and 73%, respectively) for the diagnosis of CAD in women.
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Although these imaging modalities have not been compared directly, it appears that exercise stress echocardiography and SPECT have similar prognostic value in the prediction of cardiac events and death in women. In a meta-analysis of exercise echocardiography and SPECT imaging by Metz et al, both exercise imaging modalities had the same NPV in women (99% versus 98%, respectively), which was similar to our findings in men. The authors suggested that the use of either imaging modality was appropriate for either gender, and the choice of test should depend on the experience and cost at individual institutions.
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