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Update in Cardiology
1999-2000 Series: Update Sessions from ACP-ASIM's 1999 Annual Session
Margaret Ring Gillock, Editor, and David Cramer, MD, Co-Editor
The results of studies published in 1998 were important to the practice of cardiology in six main areas of interest. Five of these are discussed here: evaluation of chest pain, acute coronary syndromes, valvular heart disease, congestive heart failure, and coronary risk factors. The sixth topic—coronary disease prevention—was covered in a discussion of two articles (1, 2) in the Update in General Internal Medicine (3).
Evaluation of Chest Pain
Exercise Treadmill Testing Is Recommended for Both Men and Women with Suspected Coronary Artery Disease
Alexander KP, Shaw LJ, Shaw LK, et al. Value of exercise treadmill testing in women. J Am Coll Cardiol. 1998; 32:1657-64.
The goal of the study was to determine whether a validated treadmill score, the Duke treadmill score (DTS), can provide accurate diagnostic and prognostic risk estimates in women. Exercise electrocardiography is the most often used and least costly noninvasive test for the evaluation of chest pain, but its dependability in women has been questioned because of a relatively high rate of false-positive results.
This cohort study looked at 3225 patients (2249 men and 976 women) with chest pain. The patients underwent an exercise treadmill test (Bruce protocol) and diagnostic cardiac catheterization at Duke Medical Center in Durham, North Carolina, between 1984 and 1994 and were followed for at least 2 years. The three selected outcomes were significant coronary artery disease (defined as one vessel with 75% stenosis), severe coronary artery disease (defined as three vessels with 75% stenosis or left main disease), and survival. The DTS was calculated by inserting the patient's results into the following formula:
DTS = Exercise time in minutes − (5 × ST deviation) − (4 × treadmill angina score),
where ST = the greatest depression or elevation measured 0.06 seconds after the J point and treadmill angina score is defined as none = 0, nonlimiting during …
