Comparative effectiveness of exercise electrocardiography with or without myocardial perfusion single photon emission computed tomography in women with suspected coronary artery disease: results from the What Is the Optimal Method for Ischemia Evaluation


BACKGROUND:There is a paucity of randomized trials regarding diagnostic testing in women with suspected coronary artery disease (CAD). It remains unclear whether the addition of myocardial perfusion imaging (MPI) to the standard ECG exercise treadmill test (ETT) provides incremental information to improve clinical decision making in women with suspected CAD. METHODS AND RESULTS:We randomized symptomatic women with suspected CAD, an interpretable ECG, and ≥5 metabolic equivalents on the Duke Activity Status Index to 1 of 2 diagnostic strategies: ETT or exercise MPI. The primary end point was 2-year incidence of major adverse cardiac events, defined as CAD death or hospitalization for an acute coronary syndrome or heart failure. A total of 824 women were randomized to ETT or exercise MPI. For women randomized to ETT, ECG results were normal in 64%, indeterminate in 16%, and abnormal in 20%. By comparison, the exercise MPI results were normal in 91%, mildly abnormal in 3%, and moderate to severely abnormal in 6%. At 2 years, there was no difference in major adverse cardiac events (98.0% for ETT and 97.7% for MPI; P=0.59). Compared with ETT, index testing costs were higher for exercise MPI (P<0.001), whereas downstream procedural costs were slightly lower (P=0.0008). Overall, the cumulative diagnostic cost savings was 48% for ETT compared with exercise MPI (P<0.001). CONCLUSIONS:In low-risk, exercising women, a diagnostic strategy that uses ETT versus exercise MPI yields similar 2-year posttest outcomes while providing significant diagnostic cost savings. The ETT with selective follow-up testing should be considered as the initial diagnostic strategy in symptomatic women with suspected CAD. CLINICAL TRIAL REGISTRATION: Unique identifier: NCT00282711.






Shaw LJ,Mieres JH,Hendel RH,Boden WE,Gulati M,Veledar E,Hachamovitch R,Arrighi JA,Merz CN,Gibbons RJ,Wenger NK,Heller GV,WOMEN Trial Investigators.




Has Abstract


2011-09-13 00:00:00














  • Low-density lipoprotein postsecretory modification, monocyte function, and circulating adhesion molecules in type 2 diabetic patients with and without macrovascular complications: the effect of alpha-tocopherol supplementation.

    abstract:BACKGROUND:Although diabetes confers an increased propensity toward accelerated atherogenesis, data are lacking on monocyte activity in type 2 diabetic patients with (DM2-MV) and without (DM2) macrovascular disease compared with control subjects. Thus, we tested whether (1) postsecretory modifications of LDL (glycation...


    pub_type: 杂志文章


    authors: Devaraj S,Jialal I

    更新日期:2000-07-11 00:00:00

  • Splanchnic venous pressure-volume relation during experimental acute ischemic heart failure. Differential effects of hydralazine, enalaprilat, and nitroglycerin.

    abstract:BACKGROUND:Vasodilator drugs have variable effects on veins and arteries. However, direct measurements of their effects on the splanchnic veins, perhaps the most important volume reservoir, have not been reported. We assessed the effect of acute heart failure and the subsequent administration of hydralazine, enalaprila...


    pub_type: 杂志文章


    authors: Wang SY,Manyari DE,Scott-Douglas N,Smiseth OA,Smith ER,Tyberg JV

    更新日期:1995-02-15 00:00:00

  • Quantitative measurements of cardiac phosphorus metabolites in coronary artery disease by 31P magnetic resonance spectroscopy.

    abstract:BACKGROUND:31P metabolite measurements in the human heart by magnetic resonance spectroscopy (MRS) have been reported previously. By use of a method in which metabolite content was quantified with reference to a standard located outside the chest, it has become possible to measure the content of phosphocreatine (PCr) a...


    pub_type: 杂志文章


    authors: Yabe T,Mitsunami K,Inubushi T,Kinoshita M

    更新日期:1995-07-01 00:00:00

  • Regional wave travel and reflections along the human aorta: a study with six simultaneous micromanometric pressures.

    abstract::The human aorta and its terminal branches were investigated in normal subjects during elective cardiac catheterization to evaluate regional wave travel and arterial wave reflections. A specially designed catheter with six micromanometers equally spaced at 10 cm intervals was positioned with the tip sensor in the dista...


    pub_type: 杂志文章


    authors: Latham RD,Westerhof N,Sipkema P,Rubal BJ,Reuderink P,Murgo JP

    更新日期:1985-12-01 00:00:00

  • Antianginal and antiischemic effects of ivabradine, an I(f) inhibitor, in stable angina: a randomized, double-blind, multicentered, placebo-controlled trial.

    abstract:BACKGROUND:Heart rate reduction should benefit patients with chronic stable angina by improving myocardial perfusion and reducing myocardial oxygen demand. This study evaluated the antianginal and antiischemic effects of ivabradine, a new heart rate-lowering agent that acts specifically on the sinoatrial node. METHODS...


    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Borer JS,Fox K,Jaillon P,Lerebours G,Ivabradine Investigators Group.

    更新日期:2003-02-18 00:00:00

  • Does myocardial stunning contribute to infarct size limitation by ischemic preconditioning?

    abstract:BACKGROUND:The mechanism through which ischemic preconditioning causes cardioprotection is unknown. The present study investigated the role of stunning in preconditioning. METHODS AND RESULTS:We studied three different protocols of preconditioning: two cycles of 2-minute ischemia separated by 5-minute reperfusion (2'P...


    pub_type: 杂志文章


    authors: Miura T,Goto M,Urabe K,Endoh A,Shimamoto K,Iimura O

    更新日期:1991-12-01 00:00:00

  • Effects of stress and beta-blockade on platelet function.

    abstract::Platelet function can be assessed by various techniques in vitro or in vivo, but methodological problems in the field are considerable. By use of the conventional in vitro technique (Born aggregometry), it has been shown that sympathoadrenal activation in vivo (e.g., mental stress, epinephrine infusions, exercise, and...


    pub_type: 杂志文章,评审


    authors: Hjemdahl P,Larsson PT,Wallén NH

    更新日期:1991-12-01 00:00:00

  • Antithrombotic effects of thrombolytic agents in a platelet-rich femoral vein thrombosis model in the hamster.

    abstract:BACKGROUND:The extent and mechanism of the antithrombotic properties of fibrin-selective and non-fibrin-selective thrombolytic agents have not yet been established. METHODS AND RESULTS:The antithrombotic, thrombolytic, fibrinogenolytic, and pharmacokinetic properties of the following substances were determined in hams...


    pub_type: 杂志文章


    authors: Stassen JM,Nyström A,Hoylaerts M,Collen D

    更新日期:1995-03-01 00:00:00

  • Pathological healing response of explanted MitraClip devices.

    abstract:BACKGROUND:The safety and effectiveness of the MitraClip device (Abbott Vascular, Menlo Park, CA) is being evaluated in the Endovascular Valve Edge-to-Edge Repair Study (EVEREST) clinical studies. The healing response after device implantation has not previously been characterized in humans. METHODS AND RESULTS:A tota...


    pub_type: 杂志文章,随机对照试验


    authors: Ladich E,Michaels MB,Jones RM,McDermott E,Coleman L,Komtebedde J,Glower D,Argenziano M,Feldman T,Nakano M,Virmani R,Endovascular Valve Edge-to-Edge Repair Study (EVEREST) Investigators.

    更新日期:2011-04-05 00:00:00

  • S-nitrosoglutathione reduces the rate of embolization in humans.

    abstract:BACKGROUND:Antiplatelet agents presently used in the secondary prevention of cardiovascular disease fail to prevent the majority of cases of recurrent stroke and systemic embolization. An evaluation of the efficacy of new agents is hampered by a lack of in vivo models in humans. Asymptomatic cerebral embolic signals (E...


    pub_type: 临床试验,杂志文章


    authors: Molloy J,Martin JF,Baskerville PA,Fraser SC,Markus HS

    更新日期:1998-10-06 00:00:00

  • Influenza infection promotes macrophage traffic into arteries of mice that is prevented by D-4F, an apolipoprotein A-I mimetic peptide.

    abstract:BACKGROUND:We reported that HDL loses its antiinflammatory properties during acute influenza A infection in mice, and we hypothesized that these changes might be associated with increased trafficking of macrophages into the artery wall. The present study tested this hypothesis. METHODS AND RESULTS:D-4F, an apolipoprot...


    pub_type: 杂志文章


    authors: Van Lenten BJ,Wagner AC,Anantharamaiah GM,Garber DW,Fishbein MC,Adhikary L,Nayak DP,Hama S,Navab M,Fogelman AM

    更新日期:2002-08-27 00:00:00

  • Can adenosine 5'-triphosphate be used to select treatment in severe vasovagal syndrome?

    abstract:BACKGROUND:Selection of treatment in vasovagal syndrome should be guided by the mechanism of symptoms. This study determined whether a simple drug test may assess one mechanism. METHODS AND RESULTS:To identify patients at risk of severe cardioinhibitory response of vagal origin, we infused 20 mg ATP into 316 patients ...


    pub_type: 杂志文章


    authors: Flammang D,Church T,Waynberger M,Chassing A,Antiel M

    更新日期:1997-08-19 00:00:00

  • Alteration in left ventricular diastolic filling and accumulation of myocardial collagen at insulin-resistant prediabetic stage of a type II diabetic rat model.

    abstract:BACKGROUND:Considerable controversy exists regarding impairment of cardiac function in diabetes mellitus (DM). We investigated the serial changes in left ventricular (LV) histopathology and LV filling dynamics in Otsuka Long-Evans Tokushima Fatty (OLETF) rats, which have been established as an animal model of type II D...


    pub_type: 杂志文章


    authors: Mizushige K,Yao L,Noma T,Kiyomoto H,Yu Y,Hosomi N,Ohmori K,Matsuo H

    更新日期:2000-02-29 00:00:00

  • Transcriptomic and proteomic patterns of systemic inflammation in on-pump and off-pump coronary artery bypass grafting.

    abstract:BACKGROUND:Coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB) provides controlled operative conditions but induces a whole-body inflammatory response capable of initiating devastating morbidity and mortality. Although technically more demanding, deliberate avoidance of CPB in off-pump surgery att...


    pub_type: 杂志文章


    authors: Tomic V,Russwurm S,Möller E,Claus RA,Blaess M,Brunkhorst F,Bruegel M,Bode K,Bloos F,Wippermann J,Wahlers T,Deigner HP,Thiery J,Reinhart K,Bauer M

    更新日期:2005-11-08 00:00:00

  • Prodromal angina limits infarct size. A role for ischemic preconditioning.

    abstract:BACKGROUND:In the experimental setting, it has been demonstrated that preconditioning myocardium before prolonged occlusion with brief ischemic episodes affords substantial protection to the cells by delaying lethal injury, thereby limiting infarct size. Whether the same occurs in humans remains unknown. METHODS AND R...


    pub_type: 杂志文章


    authors: Ottani F,Galvani M,Ferrini D,Sorbello F,Limonetti P,Pantoli D,Rusticali F

    更新日期:1995-01-15 00:00:00

  • Sodium, blood pressure, and cardiovascular disease: further evidence supporting the American Heart Association sodium reduction recommendations.

    abstract::Recent reports of selected observational studies and a meta-analysis have stirred controversy and have become the impetus for calls to abandon recommendations for reduced sodium intake by the US general population. A detailed review of these studies documents substantial methodological concerns that limit the usefulne...


    pub_type: 共识发展会议,杂志文章


    authors: Whelton PK,Appel LJ,Sacco RL,Anderson CA,Antman EM,Campbell N,Dunbar SB,Frohlich ED,Hall JE,Jessup M,Labarthe DR,MacGregor GA,Sacks FM,Stamler J,Vafiadis DK,Van Horn LV

    更新日期:2012-12-11 00:00:00

  • Cardiac interbeat interval dynamics from childhood to senescence : comparison of conventional and new measures based on fractals and chaos theory.

    abstract:BACKGROUND:New methods of R-R interval variability based on fractal scaling and nonlinear dynamics ("chaos theory") may give new insights into heart rate dynamics. The aims of this study were to (1) systematically characterize and quantify the effects of aging from early childhood to advanced age on 24-hour heart rate ...


    pub_type: 杂志文章


    authors: Pikkujämsä SM,Mäkikallio TH,Sourander LB,Räihä IJ,Puukka P,Skyttä J,Peng CK,Goldberger AL,Huikuri HV

    更新日期:1999-07-27 00:00:00

  • Reliability of multicenter pediatric echocardiographic measurements of left ventricular structure and function: the prospective P(2)C(2) HIV study.

    abstract:BACKGROUND:To assess the reliability of pediatric echocardiographic measurements, we compared local measurements with those made at a central facility. METHODS AND RESULTS:The comparison was based on the first echocardiographic recording obtained on 735 children of HIV-infected mothers at 10 clinical sites focusing on...


    pub_type: 临床试验,杂志文章,多中心研究


    authors: Lipshultz SE,Easley KA,Orav EJ,Kaplan S,Starc TJ,Bricker JT,Lai WW,Moodie DS,Sopko G,Schluchter MD,Colan SD

    更新日期:2001-07-17 00:00:00

  • Hemodynamic evaluation of the heart with a nonfluoroscopic electromechanical mapping technique.

    abstract:BACKGROUND:Clinical cardiac volumetric measurement techniques are essential for assessing cardiac performance but produce significant inaccuracies in extrapolation of the volume of a three-dimensional (3D) object from two-dimensional images and lack the ability to associate cardiac electrical and mechanical activities....


    pub_type: 杂志文章


    authors: Gepstein L,Hayam G,Shpun S,Ben-Haim SA

    更新日期:1997-11-18 00:00:00

  • Increased plasma levels of brain natriuretic peptide in patients with acute myocardial infarction.

    abstract:BACKGROUND:Brain natriuretic peptide is a novel natriuretic peptide that is secreted predominantly from the ventricles, and its plasma levels have been shown to be markedly increased in patients with chronic congestive heart failure. This study was designed to examine the plasma levels of brain natriuretic peptide as w...


    pub_type: 杂志文章


    authors: Morita E,Yasue H,Yoshimura M,Ogawa H,Jougasaki M,Matsumura T,Mukoyama M,Nakao K

    更新日期:1993-07-01 00:00:00

  • Treatment of Helicobacter pylori and Chlamydia pneumoniae infections decreases fibrinogen plasma level in patients with ischemic heart disease.

    abstract:BACKGROUND:Chronic Chlamydia pneumoniae and Helicobacter pylori infections could be a risk factor for ischemic heart disease (IHD), possibly by increasing fibrinogen levels. The aim of our study was to evaluate changes in fibrinogen level in patients with IHD and H pylori and/or C pneumoniae positivity randomly assigne...


    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Torgano G,Cosentini R,Mandelli C,Perondi R,Blasi F,Bertinieri G,Tien TV,Ceriani G,Tarsia P,Arosio C,Ranzi ML

    更新日期:1999-03-30 00:00:00

  • A Tale of Two Patients: Patient-Centered Approaches to Adherence as a Gateway to Reducing Disparities.

    abstract::The disparate effects of social determinants of health on cardiovascular health status and health care have been extensively documented by epidemiology. Yet, very little attention has been paid to how understanding and addressing social determinants of health might improve the quality of clinical interactions, especia...


    pub_type: 杂志文章


    authors: Kressin NR,Chapman SE,Magnani JW

    更新日期:2016-06-14 00:00:00

  • Hospital delays in reperfusion for ST-elevation myocardial infarction: implications when selecting a reperfusion strategy.

    abstract:BACKGROUND:It has been suggested that the survival benefit associated with primary percutaneous coronary intervention (PPCI) in ST-segment elevation myocardial infarction may be attenuated if door-to-balloon (DB) time is delayed by >1 hour beyond door-to-needle (DN) times for fibrinolytic therapy. Whereas DB times are ...


    pub_type: 杂志文章


    authors: Pinto DS,Kirtane AJ,Nallamothu BK,Murphy SA,Cohen DJ,Laham RJ,Cutlip DE,Bates ER,Frederick PD,Miller DP,Carrozza JP Jr,Antman EM,Cannon CP,Gibson CM

    更新日期:2006-11-07 00:00:00

  • Observational comparison of event-free survival with medical and surgical therapy in patients with coronary artery disease. 20 years of follow-up.

    abstract:BACKGROUND:The purpose of this study was to describe the long-term event-free survival patterns of patients with significant coronary artery disease treated medically versus patterns of those treated surgically and to evaluate the factors associated with improved event-free survival. METHODS AND RESULTS:We studied the...


    pub_type: 杂志文章


    authors: Muhlbaier LH,Pryor DB,Rankin JS,Smith LR,Mark DB,Jones RH,Glower DD,Harrell FE Jr,Lee KL,Califf RM

    更新日期:1992-11-01 00:00:00

  • L-4F, an apolipoprotein A-1 mimetic, dramatically improves vasodilation in hypercholesterolemia and sickle cell disease.

    abstract:BACKGROUND:Hypercholesterolemia and sickle cell disease (SCD) impair endothelium-dependent vasodilation by dissimilar mechanisms. Hypercholesterolemia impairs vasodilation by a low-density lipoprotein (LDL)-dependent mechanism. SCD has been characterized as a chronic state of inflammation in which xanthine oxidase (XO)...


    pub_type: 杂志文章


    authors: Ou J,Ou Z,Jones DW,Holzhauer S,Hatoum OA,Ackerman AW,Weihrauch DW,Gutterman DD,Guice K,Oldham KT,Hillery CA,Pritchard KA Jr

    更新日期:2003-05-13 00:00:00

  • Saphenous vein grafts with multiple versus single distal targets in patients undergoing coronary artery bypass surgery: one-year graft failure and five-year outcomes from the Project of Ex-Vivo Vein Graft Engineering via Transfection (PREVENT) IV trial.

    abstract:BACKGROUND:Limited information exists on the intermediate-term graft patency and 5-year clinical outcomes of patients receiving saphenous vein grafts with multiple (m-SVG) versus single distal targets (s-SVG) during coronary artery bypass graft (CABG) surgery in the current era. METHODS AND RESULTS:We studied the asso...


    pub_type: 杂志文章,多中心研究,随机对照试验


    authors: Mehta RH,Ferguson TB,Lopes RD,Hafley GE,Mack MJ,Kouchoukos NT,Gibson CM,Harrington RA,Califf RM,Peterson ED,Alexander JH,Project of Ex-vivo Vein Graft Engineering via Transfection (PREVENT) IV Investigators.

    更新日期:2011-07-19 00:00:00

  • Effects of combination of ACE inhibitor and angiotensin receptor blocker on cardiac remodeling, cardiac function, and survival in rat heart failure.

    abstract:BACKGROUND:The mechanism and treatment of diastolic heart failure are poorly understood. We compared the effects of an ACE inhibitor, an angiotensin receptor blocker (ARB), and their combination on diastolic heart failure in Dahl salt-sensitive (DS) rats. METHODS AND RESULTS:DS rats fed an 8% NaCl diet from 7 weeks of...


    pub_type: 杂志文章


    authors: Kim S,Yoshiyama M,Izumi Y,Kawano H,Kimoto M,Zhan Y,Iwao H

    更新日期:2001-01-02 00:00:00

  • Exploration of the precision of classifying sudden cardiac death. Implications for the interpretation of clinical trials.

    abstract:BACKGROUND:As cardiovascular clinical trials improve in sophistication and therapies target specific cardiac mechanisms of death, a more objective and precise system to identify specific cause of death is needed. Ideally, sudden cardiac death would describe patients dying of ventricular tachycardia and ventricular fibr...


    pub_type: 杂志文章


    authors: Pratt CM,Greenway PS,Schoenfeld MH,Hibben ML,Reiffel JA

    更新日期:1996-02-01 00:00:00

  • Acute effect of intravenous dipyridamole on regional coronary hemodynamics and metabolism.

    abstract::The acute coronary hemodynamic and metabolic effects of intravenous dipyridamole were studied in 13 patients. Total left ventricular (LV), anterior (supplied by the left anterior descending coronary artery) and inferior (supplied by circumflex and right coronary arteries) regional flows and metabolic responses were as...


    pub_type: 杂志文章


    authors: Feldman RL,Nichols WW,Pepine CJ,Conti CR

    更新日期:1981-08-01 00:00:00

  • Coronary revascularization in diabetic patients: a comparison of the randomized and observational components of the Aypass Angioplasty Revascularization Investigation (BARI).

    abstract:BACKGROUND:Patients with treated diabetes in the randomized-trial segment of the Bypass Angioplasty Revascularization Investigation (BARI) who were randomized to initial revascularization with PTCA had significantly worse 5-year survival than patients assigned to CABG. This treatment difference was not seen among diabe...


    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Detre KM,Guo P,Holubkov R,Califf RM,Sopko G,Bach R,Brooks MM,Bourassa MG,Shemin RJ,Rosen AD,Krone RJ,Frye RL,Feit F

    更新日期:1999-02-09 00:00:00