The Women’s Ischemi Syndrome Evaluation (WISE) Study: protocol design, methodology and feasibility report

OBJECTIVES The Women’s Ischemi Syndrome Evaluation (WISE) is National Heart, Lung and Blood Institute–sponsored, four-center study designed to: 1) optimize symptom evaluation and diagnostic testing for ischemic heart disease; 2) explore mechanisms for symptoms and myocardial ischemi in the absence of epicardial coronary artery stenoses, and 3) evaluate the influence of reproductive hormones on symptoms and diagnostic test response. BACKGROUND Accurate diagnosis of ischemic heart disease in women is major challenge to physicians, and the role reproductive hormones play in this diagnostic uncertainty is unexplored. Moreover, the significance and pathophysiology of ischemi in the absence of significant epicardial coronary stenoses is unknown. METHODS The WISE common core dat include demographic and clinical data, symptom and psychosocial variables, coronary angiographic and ventriculographic data, brachial artery reactivity testing, resting/ambulatory electrocardiographic monitoring and variety of blood determinations. Site-specific complementary methods include physiologic and functional cardiovascular assessments of myocardial perfusion and metabolism, ventriculography, endothelial vascular function and coronary angiography. Women are followed for at least 1 year to assess clinical events and symptom status. RESULTS In Phase I (1996–1997), pilot phase, 256 women were studied. These dat indicate that the WISE protocol is safe and feasible for identifying symptomatic women with and without significant epicardial coronary artery stenoses. CONCLUSIONS The WISE study will define contemporary diagnostic testing to evaluate women with suspected ischemic heart disease. Phase II (1997–1999) is ongoing and will study an additional 680 women, for total WISE enrollment of 936 women. Phase III (2000) will include patient follow-up, dat analysis and National Institutes of Health WISE workshop.