Gender Differences in the Accuracy of Dobutamine Stress Echocardiography for the Diagnosis of Coronary Artery Disease

Abstract

The accuracy of dobutamine stress echocardiography (DSE) for the diagnosis of coronary artery disease (CAD) has not been yet evaluated in women. We studied the effect of gender on the accuracy of DSE for the diagnosis of CAD in 306 consecutive patients (210 men and 96 women) with limited exercise capacity and suspected myocardial ischemia who underwent coronary angiography within 3 months of DSE. There were no serious complications during DSE. Men had a higher prevalence of nonsustained ventricular tachycardia (7% vs 0.03%, p <0.05) and supraventricular tachycardia (9% vs 0.03%, p <0.05) during the test compared with women. Peak stress rate-pressure product was not different in men and women (18,140 +/- 4,187 vs 18,543 +/- 4,223). Significant CAD (> or =50% luminal diameter stenosis) was present in 171 men (81%) and in 62 women (65%, p <0.005). The sensitivity, specificity, and accuracy of ischemic pattern at DSE for the diagnosis of significant CAD were 76% (confidence interval [CI] 67 to 84), 94% (CI 89 to 99), and 82% (CI 75 to 90) in women and 73% (CI 67 to 79), 77% (CI 71 to 83), and 74% (CI 68 to 80) in men, respectively. Overall specificity was higher in women than in men (p <0.05). Regional accuracy of DSE was significantly higher in women than in men in the 3 arterial regions (84% [CI 79 to 88] vs 75% [CI 72 to 79], p <0.005). It is concluded that DSE is a safe and feasible method for the diagnosis of CAD in women. The overall specificity and the regional accuracy of DSE are higher in women than in men. Further studies are required to evaluate the functional significance of these findings and their reproducibility in different patient populations.

Role of Noninvasive Testing in the Clinical Evaluation of Women With Suspected Coronary Artery Disease

“…DSE had a higher sensitivity but a lower specificity than those of stress echocardiography performed with dipyridamole or adenosine. 75,76 Similar to the results for exercise stress echocardiography in women, the diagnostic accuracy of DSE to detect CAD in women appears to be similar to that in men.…”

Comparative accuracy of real-time myocardial contrast perfusion imaging and wall motion analysis during dobutamine stress echocardiography for the diagnosis of coronary artery disease

“…Diagnostic accuracy in the three coronary arterial distributions. Previous studies have demonstrated a modest sensitivity for DSE in diagnosing significant CAD in an individual coronary artery as well as in patients with singlevessel CAD (1)(2)(3)(4)(5)(6)(7). In this study, MCE had a significantly higher sensitivity and accuracy than WMA for the diagnosis of LAD, RCA, and LCx CAD.…”

“…However, pooled data have shown that the sensitivity of wall motion analysis (WMA) is modest, particularly in patients with single-vessel CAD (1)(2)(3)(4)(5)(6)(7). Although patients with multivessel CAD often demonstrate wall motion abnormalities during DSE, abnormalities are often detected in a single vascular region, with underestimation of the extent of CAD (1).…”

Role of Noninvasive Testing in the Clinical Evaluation of Women With Suspected Ischemic Heart Disease

“…108 The majority of dobutamine stress echocardiography studies in women have reported sensitivities ranging from 75% to 93% and specificities from 79% to 92%. [113][114][115][116][117] A meta-analysis of dobutamine stress echocardiography found an overall sensitivity of 80% (95% CI, 77%-83%) and specificity of 84% (95% CI, 80%-86%). 108 For exercise and dobutamine stress echocardiography, the diagnostic accuracy is generally comparable among women and men, although the prevalence of CAD by angiography is generally lower for women.…”