Comparison of “Rose questionnaire angina” to exercise thallium scintigraphy: Different findings in males and females

Validation of the London School of Hygiene (Rose) Questionnaire with objective measures of myocardial ischemia is incomplete. Therefore, we compared the Rose Questionnaire with exercise thallium-201 myocardial scintigraphy in 147 male and 97 female patients with chest pain referred for clinical exercise testing. Of those with “Rose Questionnaire angina”, 26% of the females and 73% of the males had positive thallium-201 scans. Negative results on both the Rose Questionnaire and thallium-201 scintigraphy were observed in 71 % of the females and 47% of the males. The sensitivity of the Rose Questionnaire was similar in females (41 %) and males (44%). The specificity was 77% in males, while in females it was significantly lower at 56%. The specificity values reflect the higher ( p < 0.05) prevalence of “false positive” Rose Questionnaire results in females (75%) compared with males (27%). In addition, males had a greater ( p < 0.05) number of “false negative” results (53%) than females (29%). The accuracy of the Rose Questionnaire for myocardial ischemia was 0.19 in females, 0.48 in males, and 0.29 overall when including both males and females. Our results indicate a generally poor relationship between Rose Questionnaire angina and thallium-201 scintigraphy, an objective measure of myocardial ischemia in patients with chest pain referred to clinical exercise testing. Further, there are gender-specific differences in this relationship between the questionnaire and exercise thallium-201 imaging.