Head to Head Comparison of Stress Echocardiography with Exercise Electrocardiography for the Detection of Coronary Artery Stenosis in Women

Abstract

BackgroundExercise-stress electrocardiography (ECG) is initially recommended for the diagnosis of coronary artery disease. But its value has been questioned in women because of suboptimal diagnostic accuracy. Stress echocardiography had been reported to have comparable test accuracy in women. But the data comparing the diagnostic accuracy of exercise-stress ECG and stress echocardiography directly are few. The aim of the study was to compare the diagnostic accuracy of exercise-stress ECG and dobutamine stress echocardiography (DSE) in Korean women.Methods202 consecutive female patients who presented with chest pain in outpatient clinic, and who underwent treadmill exercise test (TET), DSE and coronary angiography were included for the study. The diagnostic accuracy TET and DSE were calculated by the definition of > 50% or > 75% coronary artery stenosis (CAS).ResultsThe sensitivity and specificity were higher with DSE (70.4, 94.6%) than TET (53.7, 73.6%) for detection of > 50% CAS. The higher accuracy of DSE was maintained after exclusion of the patients who could not achieve over 85% age predicted heart rate before ischemia induction. DSE also showed greater diagnostic accuracy than TET by > 75% CAS criteria, and in subsets of patient with intermediate pretest probability.ConclusionIn the diagnosis of CAS, DSE showed higher accuracy than TET in female patients who presented with chest pain. As well as the test accuracy, adequate stress was more feasible with DSE than TET. These finding suggests DSE may be used as the first-line diagnostic tool in the detection of CAS in women with chest pain.

Postnatal undernutrition in mice causes cardiac arrhythmogenesis which is exacerbated when pharmacologically stressed

“…[26][27][28][29] Dobutamine acts on the β1 receptors of the sympathetic nervous system to stimulate an increase in stroke volume by causing an inotropic effect on the heart, with a secondary response to increase heart rate (HR) and blood pressure. 26,28,29 A growing use for dobutamine administration has been in the use of Pharmacological Stress Echocardiography to observe cardiac function and diagnose cardiovascular disease. 26,28 Pharmacological stress testing is an alternative method to dynamic exercise testing that when combined with noninvasive imaging allows for the detection of myocardial impairment.…”

“…Dobutamine is a common adrenergic agent used to increase cardiac output 26 29 Dobutamine acts on the β1 receptors of the sympathetic nervous system to stimulate an increase in stroke volume by causing an inotropic effect on the heart, with a secondary response to increase heart rate (HR) and blood pressure 26 28 , 29 A growing use for dobutamine administration has been in the use of Pharmacological Stress Echocardiography to observe cardiac function and diagnose cardiovascular disease 26 …”

Polish Stress Echocardiography Registry (Pol-STRESS registry) — a multicentre study. Stress echocardiography in Poland: numbers, settings, results, and complications

“…At the same time, as highlighted in the ESC guidelines [11], these patients often present with atypical symptoms. Literature data indicate a varying proportion of SE examinations positive for myocardial ischaemia [6,12]. We believe that even large randomised studies may not answer the question regarding the actual proportion of positive SE test results.…”

Clinical Study of Cardiovascular Involvement in Patients with Connective Tissue Diseases

“…The presence of different signs was evaluated using chest X-ray including upper zone flow redistribution, lung interstitial edema, alveolar pulmonary edema, bilateral pleural effusion, and cardiomegaly [11]. However, echocardiography has a higher sensitivity for detection of cardiovascular disease [12]. Therefore, the present study was to investigate the extent of cardiac abnormalities associated with CTD patients using clinical examination and non-invasive methods.…”