CLINICAL INTEREST OF MEASUREMENT OF SYSTO LIC BLOOD-PRESSURE IN POSTEXERCISE TESTING FOR EVALUATION AND DIAGNOSIS OF CORONARY-ARTERY DISEASE - COMPARATIVE-STUDY OF WOMEN AND MEN

It has been demonstrated that the ratio of the systolic blood pressure post-exercise to that at peak exercise (rSBP) is a criterion for diag nosis and severity of coronary artery disease (CAD) in men. No such de monstration has been attempted in women. We have compared rSBP to clas sical signs of ischemia, such as ST segment depression and angina pect oris, in a group of 788 ambulatory patients of whom 357 were women. Al l underwent a bicycle ergometric test and a coronary angiogram. The pr evalence of CAD at angiography was the same for both genders (women 43 .5% and men 47%) with no significant difference in the number of vesse ls diseased. In patients with CADI the rSBP was significantly more ele vated than in others, at 1 minute (p <0.01) and even more so at 3 minu tes (p <0.001) post-exercise, with no gender difference. The most disc riminating value of rSBP at 3 minutes post-exercise for diagnosis of C AD was situated at 0.91 for sensitivity and specificity (receiver: ope rating characteristic curve analysis). In the whole group sensitivity of rSBP is lower, while the specificity is greater than classical crit eria of ischemia. The sensitivity of rSBP is poor for the diagnosis of single vessel disease, but of equal value compared to ST segment depr ession iii the presence of multivessel disease, with no gender differe nce. The specificity of rSBP is higher than ST segment depression in w omen (p <0.001) compared to men (p <0.05). rSBP has a positive correla tion with the number of coronary vessels diseased but not with the ext ent of ST segment depression. Our study demonstrates that rSBP at 3 mi nutes post-exercise is a less good diagnostic sign than the classical criteria of myocardial ischemia. However, rSBP has good specificity, p articularly in women, thus reducing false positive tests related to ST segment depression. rSBP is also a marker of the severity of coronary artery disease.