Exercise echocardiography is an accurate and cost-efficient technique for detection of coronary artery disease in women

Marwick, Thomas H.; Anderson, Tracy; Williams, Michelle; Haluska, Brian; Melin, Jacques; Pashkow, Fredric J.; Thomas, James D.

doi:10.1016/0735-1097(95)80004-z

Cited by 250 publications

(84 citation statements)

References 28 publications

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“…18,19 In the present study specificity of ECG stress test in women was only 50% ( Table 2). The advantage of stress echocardiography over ECG stress test was more obvious in hypertensive women than in hypertensive men.…”

Section: Discussioncontrasting

confidence: 56%

“…The other study that included patients with no defined blood pressure, revealed that exercise echo was also slightly more sensitive than dobutamine (76% vs 72%) but less specific (94% vs 97%). 19 In this study the exercise in comparison to dobutamine echocardiography was associated with the larger extent of the left ventricular wall motion abnormalities. This factor may facilitate recognition of abnormal left ventricular wall motion during echocardiography.…”

Section: Discussionmentioning

confidence: 53%

“…In an earlier study exercise echocardiography was found to be the optimal method of diagnosing coronary artery disease in women. 19 The present study is the first which compares exercise and dobutamine echocardiography exclusively in hypertensive patients with angina. No significant difference in specificity was found (96% vs 98%) but the trend for higher sensitivity of exercise than dobutamine echocardiography was observed (82% vs 74%, P = 0.10).…”

Section: Discussionmentioning

confidence: 98%

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Advantages of exercise echocardiography in comparison to dobutamine echocardiography in the diagnosis of coronary artery disease in hypertensive subjects

et al. 2001

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Objective: The aim of the study was to compare the efficacy and safety of two stress echocardiography methods, exercise and dobutamine, in the diagnosis of coronary artery disease in hypertensive patients with angina. Patients and methods: A total of 197 treated hypertensive patients, age 53 ؎ 9 years (65 women) with no history of myocardial infarction referred for coronary angiography were prospectively investigated with exercise electrocardiography (ECG), exercise and dobutamine echocardiography. Results: Sensitivity of the exercise ECG, exercise echocardiography and dobutamine echocardiography did not differ (77%, 82% and 75%). Negative predictive value of exercise ECG was significantly lower than exercise echocardiography (64% vs 79%, P Ͻ 0.01). Specificity and positive predictive value of exercise ECG were markedly lower than exercise and dobutamine echocar-

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 98%

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Advantages of exercise echocardiography in comparison to dobutamine echocardiography in the diagnosis of coronary artery disease in hypertensive subjects

et al. 2001

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“…This gender difference remains even when combining the interpretation of ST-segment deviation with exercise time and exercise induced symptoms into the Duke Treadmill Score (DTS) [11,12]. These difficulties posed on the clinical determination of CAD probability have led to speculation that stress imaging approaches may be an efficient initial alternative to exercise ECG in women [13], however few data are available to support this approach.…”

Section: Introductionmentioning

confidence: 99%

Comparison of exercise electrocardiography and stress perfusion CMR for the detection of coronary artery disease in women

Greulich

Bruder

Parker

et al. 2012

Journal of Cardiovascular Magnetic Resonance

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BackgroundExercise electrocardiography (ECG) is frequently used in the work-up of patients with suspected coronary artery disease (CAD), however the accuracy is reduced in women. Cardiovascular magnetic resonance (CMR) stress testing can accurately diagnose CAD in women. To date, a direct comparison of CMR to ECG has not been performed.Methods and resultsWe prospectively enrolled 88 consecutive women with chest pain or other symptoms suggestive of CAD. Patients underwent a comprehensive clinical evaluation, exercise ECG, a CMR stress test including perfusion and infarct imaging, and x-ray coronary angiography (CA) within 24 hours. CAD was defined as stenosis ≥70% on quantitative analysis of CA.Exercise ECG, CMR and CA was completed in 68 females (age 66.4 ± 8.8 years, number of CAD risk factors 3.5 ± 1.4). The prevalence of CAD on CA was 29%. The Duke treadmill score (DTS) in the entire group was −3.0 ± 5.4 and was similar in those with and without CAD (−4.5 ± 5.8 and −2.4 ± 5.1; P = 0.12). Sensitivity, specificity and accuracy for CAD diagnosis was higher for CMR compared with exercise ECG (sensitivities 85% and 50%, P = 0.02, specificities 94% and 73%, P = 0.01, and accuracies 91% and 66%, P = 0.0007, respectively). Even after applying the DTS the accuracy of CMR was higher compared to exercise ECG (area under ROC curve 0.94 ± 0.03 vs 0.56 ± 0.07; P = 0.0001).ConclusionsIn women with intermediate-to-high risk for CAD who are able to exercise and have interpretable resting ECG, CMR stress perfusion imaging has higher accuracy for the detection of relevant obstruction of the epicardial coronaries when directly compared to exercise ECG.

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“…It has been reported that exercise [7][8][9] and dipyridamole echocardiography 10 may be better noninvasive tests for diagnosis of CAD in women. Dobutamine stress echocardiography (DOBE) is increasingly used for detection of CAD, 11,12 but its diagnostic accuracy has not been defined in women.…”

Section: Introductionmentioning

confidence: 99%

Dobutamine stress echocardiography in the diagnosis of coronary artery disease in women with chest pain: Comparison with different noninvasive tests

Rollán

Román

Vilacosta

et al. 2002

Clinical Cardiology

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SummaryBackground: Diagnosis of coronary artery disease (CAD) in women remains elusive. The classical diagnostic armamentarium has been found to be very limited. Dobutamine stress echocardiography has emerged as a powerful test in assessing CAD in the general population, but most studies failed to include women.Hypothesis: The accuracy of dobutamine stress echocardiography in the diagnosis of CAD in women with chest pain is high and superior to dipyridamole echocardiography, exercise electrocardiography, and sestamibi single-photon emission tomography (MIBI-SPECT) scintigraphy.Methods: We studied 99 consecutive women with chest pain and no previous history of CAD who underwent dobutamine echocardiography and coronary angiography. We also compared these results with those of dipyridamole echocardiography in 63 patients, exercise stress testing in 83 (48 conclusive), and MIBI-SPECT scintigraphy during dobutamine infusion in 54.Results: Significant CAD was found in 42 women. Sensitivity and specificity of dobutamine stress echocardiography were 69 and 89%, respectively. Dipyridamole echocardiogra-

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Exercise echocardiography is an accurate and cost-efficient technique for detection of coronary artery disease in women

Abstract: Exercise echocardiography is more specific than exercise electrocardiography for diagnosis of coronary artery disease in women and is a cost-effective approach to the diagnosis of coronary artery disease because of the avoidance of inappropriate angiography.

Cited by 250 publications

References 28 publications

Advantages of exercise echocardiography in comparison to dobutamine echocardiography in the diagnosis of coronary artery disease in hypertensive subjects

Advantages of exercise echocardiography in comparison to dobutamine echocardiography in the diagnosis of coronary artery disease in hypertensive subjects

Comparison of exercise electrocardiography and stress perfusion CMR for the detection of coronary artery disease in women

Dobutamine stress echocardiography in the diagnosis of coronary artery disease in women with chest pain: Comparison with different noninvasive tests

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