The Women's Ischemia Syndrome Evaluation (WISE)
Objectives:
This is a National Heart, Lung and Blood
Institutesponsored, four-center study designed to: 1) optimize symptom
evaluation and diagnostic testing for ischemic heart disease; 2) explore
mechanisms for symptoms and myocardial ischemia in the absence of epicardial
coronary artery stenoses, and 3) evaluate the influence of reproductive
hormones on symptoms and diagnostic test response.
Background:
Women tend to have a higher prevalence of chest pain
than men, yet a lower prevalence of epicardial coronary stenoses, and
diagnostic tests such as exercise-induced ECG changes tend to have a higher
false-positive rate in women than in men. Thus, accurate diagnosis of ischemic
heart disease in women is a major challenge to physicians. In addition,
prognosis in women with abnormal diagnostic tests is largely unknown and the
role reproductive hormones play in this diagnostic uncertainty is unexplored.
Moreover, the significance and pathophysiology of ischemia in the absence of
significant epicardial coronary stenoses is unknown.
Subjects:
In Phase I (19961997), a pilot phase, 256 women
were studied. During Phase II (1997-1999) angiographic and baseline data were
collected on an additional 680 women to bring total enrollment to 936. Baseline
data was also collected on a reference population of 70 women. Women eligible
for participation are greater than 18 years of age, are undergoing a clinically
indicated angiogram as part of regular medical care for chest pain or suspected
myocardial ischemia. Exclusion criteria included comorbidity that would
compromise one-year followup, pregnancy, contraindications to diagnostic
testing, cardiomyopathy, NYHA class IV congestive heart failure, congenital
heart disease, or significant valvular disease.
Conclusions:
Among women without CAD, abnormal Magnetic Resonance
Spectroscopy (MRS) consistent with myocardial ischemia predicted cardiovascular
outcome, notably higher rates of anginal hospitalization, repeat catherization,
and greater treatment costs (Circulation 2004; 109:2993-9).
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Study Website |
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Study Documentation |
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Data Distribution Agreement |
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