The patient's motivation during bicycle stress ECG test is dependent on the investigator's sex in male patients

The exercise electrocardiogram is a commonly used non-invasive method for detection of electrocardiogram (ECG) changes secondary to myocardial ischemia. Studies showed the importance of the patient's motivation to reach the estimated submaximal heart rate. The purpose of this study was to test whether the patient's motivation is dependent on the investigator's sex.We included 1170 patients (in-hospital patients and out-clinic patients; 63.5% male, 36.5% female) in this study. Stress test data (stationary bicycle with gradually increasing intensity) were collected retrospectively: patient's age, sex, maximal power stage, ECG-abnormalities, angina pectoris, and attending physician's sex.Male patients achieved a higher power stage than their female counterparts (126.5 ± 47.7 W vs. 89.7 ± 30.4 W). When male patients were supervised by a female doctor they reached higher maximum power stages (136.6 ± 53.5 W vs. 121.6 ± 43.3 W; p = 0,001), more often the submaximal heart rate (47.9% vs. 38.3%; p = 0.02) but complained less frequent about angina pectoris (5.6% vs. 17.3%). In contrast, none of these parameters was dependent on the attending physician's sex in female patients.The attending physician's sex influences the maximum exercise ability and the incidence of complaints during bicycle stress in male patients but not in females. We would speculate that men try to impress women with physical strength and try to dissimulate physical discomfort or pain. This could possibly influence the validity of such non-invasive methods with exercise dependent detection of myocardial ischemia.