{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T17:40:01Z","timestamp":1777916401613,"version":"3.51.4"},"reference-count":25,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2018,5,1]],"date-time":"2018-05-01T00:00:00Z","timestamp":1525132800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Women's Health"],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>In women with low to intermediate risk of coronary artery disease (CAD), prognostic detection strategies have been controversial. We present the follow-up data of the SMART trial in peri\/postmenopausal women at low to intermediate risk of CAD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To determine the value of contrast stress echocardiography (CSE), stress electrocardiogram (sECG), and serum biomarkers for prediction of cardiovascular events (CE) in peri\/postmenopausal women at low to intermediate risk of CAD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>\n                      From January 2004 to August 2007, 400 peri\/postmenopausal women were prospectively enrolled. All women had detailed risk factor assessment, and underwent simultaneous CSE (Definity\n                      <jats:sup>\u00ae<\/jats:sup>\n                      , Lantheus Medical Imaging) and sECG. Laboratories included brain natriuretic peptide (BNP), atrial natriuretic peptide, endothelin, and high sensitivity C-reactive protein. Wall motion score index was based on a 16-segment model. Abnormal CSE was defined as new or worsening wall motion abnormality at stress, while abnormal sECG was \u22651\u2009mm horizontal\/downsloping ST segment depression\/elevation (80 mseconds duration). Self-reported outcome data were collected from a mailed Women's Heart Clinic Questionnaire. CE outcomes included all-cause mortality, nonfatal myocardial infarction (MI), heart failure, chest pain hospitalization or development of typical angina (CP), and revascularization (REVASC). Adjusted Cox proportional hazard ratios (HR; 95% confidence intervals) were reported.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 366 women (54.4\u2009\u00b1\u20095.5 years, Framingham risk 6.5%\u2009\u00b1\u20094.4%) completed simultaneous CSE and sECG. Forty-two (11.5%) had abnormal CSE, while sECG was abnormal in 22 (6%) women. Follow-up (4.4\u2009\u00b1\u20091.2 years) was available in 315\/366 (86%) women (78% exercise-CSE, 22% dobutamine-CSE). In those who completed follow-up, CSE was abnormal in 33 women (10.5%) and sECG was abnormal in 21 (6.7%). In 33 women with abnormal CSE, sECG was abnormal in 7 (21.2%) and normal in 26 (79%),\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.0004. CE occurred in 27 (8.6%) women: 8 all-cause mortality, 2 nonfatal MI, 13 CP, and 4 REVASC. CE occurred in 21% versus 7% of women with abnormal versus normal CSE,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.014 and 38% versus 6% of women with abnormal versus normal sECG,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.0001. Rest BNP was higher in women with CE versus those without (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.018). Abnormal sECG and abnormal CSE were associated with CE, while only abnormal sECG was an independent predictor of CE (adjusted HR 10.3 [1.9\u201361.4],\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.007). Of the laboratory results, only BNP was associated with CE (adjusted HR 2.9 [1.1\u20137.3],\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.028).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>sECG and rest BNP were independent predictors of subsequent CE within 5 years in peri\/postmenopausal women at low to intermediate risk of CAD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/jwh.2017.6506","type":"journal-article","created":{"date-parts":[[2018,4,19]],"date-time":"2018-04-19T15:23:19Z","timestamp":1524151399000},"page":"542-551","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":11,"title":["Prognostic Utility of Stress Testing and Cardiac Biomarkers in Menopausal Women at Low to Intermediate Risk for Coronary ARTery Disease (SMART Study): 5-Year Outcome"],"prefix":"10.1177","volume":"27","author":[{"given":"Sahar S.","family":"Abdelmoneim","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine"},{"name":"Assiut University","place":["Egypt"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline A.","family":"Ball","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Mantovani","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine"},{"name":"Arcispedale Santa Maria Nuova (IRCCS)","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary E.","family":"Hagen","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Eifert-Rain","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Wilansky","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramon","family":"Castello","sequence":"additional","affiliation":[{"name":"Memorial Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia A.","family":"Pellikka","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia J.M.","family":"Best","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine"},{"name":"Department of Cardiovascular 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