Title

The Women's Ischemia Syndrome Evaluation study: An overview of the impact on detection of ischemic heart disease in women

Document Type

Journal Article

Publication Date

10-1-1999

Journal

Cardiovascular Reviews and Reports

Volume

20

Issue

10

Abstract

Coronary artery disease (CAD) is the most common cause of mortality among women in the U.S. However, most major clinical trials addressing the diagnosis and treatment of CAD are composed primarily of men. The Women's Ischemia Syndrome Evaluation (WISE) study, conducted at four university clinical sites, aims to assess the utility of existing tests and evaluate innovative methods to improve testing in women. To date, 161 women have been enrolled at the University of Florida (UF) clinical site. Mean age of participants in the pilot phase was 57.5±10.1 years. Nearly 90% had ≥ 2 risk factors for CAD, and 27% had angiographic evidence of severe coronary stenosis. These women underwent a battery of noninvasive and invasive tests, including dobutamine stress echocardiography (DSE), invasive measures of coronary flow reserve and endothelial function, and noninvasive measure of brachial artery endothelial function. In brief, DSE performed in 92 women demonstrated overall sensitivity (excluding indeterminate tests) of 50% and 81.8% for two or three vessel stenosis, respectively. In a subset who also underwent coronary function studies, abnormal coronary flow reserve or endothelial dysfunction were identified in 67%. In the absence of severe coronary stenosis, these functional abnormalities were uncommonly associated with ischemia during DSE. Moreover, concordant abnormalities of coronary and brachial artery endothelial function were observed in only 24% of patients undergoing both studies. These findings underscore the limitations of current testing in women with chest pain and suspected ischemic heart disease, and the importance of further investigation. The major goals of the ensuing years of the WISE study are to improve the accuracy of DSE using contrast enhancement, and utilize phosphorus-31 nuclear magnetic resonance spectroscopy to determine whether ischemia due to abnormal coronary function occurs in the women without angiographic stenosis.

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