Diagnostic accuracy of treadmill exercise tests among Chinese women with coronary artery diseases: A systematic review and meta-analysis

Background: The treadmill exercise test (TET) is one of the most common noninvasive diagnosis approaches for ischemic heart diseases, but potential reduction of TET accuracy among Chinese female patients was ignored by most studies, especially in perimenopause women. Hence, we aim to perform a systematic review and meta-analysis evaluating the TET diagnostic accuracy for Chinese women compared with coronary angiography (CAG).

Methods: PubMed, MEDLINE, EMBASE, CNKI and WANFANG (1990 to 2015) were performed to identify studies assessing the diagnostic accuracy of TET versus CAG. Random effects modeling strategies were used to produce summary receiver operating characteristic (SROC) curves, including overall estimates for sensitivity and specificity.

Results: A total of 19 studies involving 2396 Chinese females were included in our systematic review. TET has moderate levels of sensitivity (0.80) and specificity (0.65) to detect coronary artery stenoses in female patients with suspected coronary artery diseases, generating 0.79 of the area under the curve (AUC). In subgroup analyses, the pooled sensitivity of postmenopause and premenopausal/perimenopausal groups were 0.83 and 0.80, respectively. However, the postmenopause group has a higher pooled specificity: 0.68 versus 0.32 compared with premenopausal/perimenopausal women, and a higher corresponding AUC (0.81 versus 0.56).

Conclusions: TET may be used as a triage test for women with suspected and subclinical CAD. The positive results of TET should be treated with caution because of its higher false-positive, especially for premenopausal/perimenopausal women, and further confirmatory diagnosis is needed. However, patients with negative TET results could be precluded for further evaluation using CAG, and avoid unnecessary risk and economic burden to patients.