Women with high exercise tolerance and the role of myocardial perfusion imaging

Background: Myocardial perfusion imaging (MPI) provides incremental diagnos tic and prognostic information, even in patients with high exercise toleran ce. Hypothesis: Myocardial perfusion imaging provides significant diagnostic va lue, specifically in women with high exercise tolerance. Methods: Our study population consisted of all women who underwent exercise MPI in our Department from January 1992 to June 1996 and reached at least Stage TV in the Bruce protocol. Patients were divided into those with known and those with possible coronary artery disease (CAD). All patients were f ollowed for 3 years from the performance of MPI. Results: Of 4,803 women who underwent myocardial per fusion imaging, 3,183 had exercise stressing, and of those, 311 reached at least Stage IV in the Bruce protocol. Of these 311 MPI scans, only 23 (7.4%) were abnormal (rever sible, fixed, or mixed) and the remaining 288 (92.6%) were normal. Of the 8 2 patients with known CAD, 13 (15.8%) had an abnormal MPI, while only 10 (4 .4%) of the 229 patients with possible CAD. No myocardial infarction or car diac death occurred within 3 years; one patient with normal MPI needed reva scularization. Conclusion: In women with high exercise tolerance, especially in those with out already known CAD, the yield of MPI is very low. Women with high exerci se tolerance have an excellent prognosis.