ISCHEMIA DETECTION IN PERIMENOPAUSAL WOMEN - A COMPARISON BETWEEN HOLTER EKG AND EXERCISE STRESS TESTING
Background: In women without very high cholesterol level, especially during “the hormonal storm” of the menopause, endothelial dysfunction and erosion, but also vasospasm can be important factors involved in ischemic heart disease. This type of ischemia could be more accurate diagnosed and evaluated by Holter EKG instead of exercise stress testing.
Method: There were studied 100 perimenopausal women, 48-53 years old (2-11 consecutive months without a menstrual period) and 100 men of the same age with suspicion of ischemic heart disease. All patients performed an exercise stress testing (ET) on cycloergometer (Labtech Cardiospy® software version 5.01.01) and a 5-channels 24-h Holter EKG (Labtech CardiospyÒ software version 5.02.03.03).
In the study were included only women and men with LDL cholesterol< 160 mg/dl. All included patients completed at least submaximal (85% of MaxHR) ET.
Results: ET was positive for ischemia in 28 % of women and 58 % of men, even if chest pain during exercise was registered in 68 % of women and 45 % of men. Heart rate and double product at peak exercise were significantly less in women (118 ±11 b/m; 16.000±1.700) than in men (132±14 b/m; 23.000±2.100 ).
In turn, on Holter EKG was registered significant ischemia in 47 % of women (10 % with also positive exercise stress test) and 51 % of men (40 % with also positive ET). Heart rate during ischemic episodes was significantly lower in women (105±9.8 b/m), than in men (115±10.4 b/m), and so was the maximal ST depression ( 1.4±0.13 mm and -1.7±0.2 mm). The data suggests that daily ischemia is more frequent in women than in man, with a possible vasospastic component but with less frequent fix coronary stenosis and ischemia during submaximal or maximal exercise.
Conclusion: In perimenopausal women , the Holter EKG is more useful than ET in detecting ischemic heart disease, but usually both methods are recommended to improve the diagnosis accuracy.