THE LIMITED EFFICACY OF EXERCISE RADIONUCLIDE VENTRICULOGRAPHY IN ASSESSING PROGNOSIS OF WOMEN WITH CORONARY-ARTERY DISEASE

Increasing numbers of women are undergoing stress testing for coronary artery disease evaluation, Limited study is available as to its effic acy in women, Four hundred nineteen patients with coronary artery dise ase (74 women and 345 men) referred for exercise radionuclide ventricu lography between 1979 and 1986 were evaluated in a prospective cohort evaluation with 5-year follow-up. Exercise radionuclide ventriculograp hic variables were analyzed and compared between women and men, The pr ognostic efficacy of exercise radionuclide ventriculography was assess ed separately for women and men among patients with coronary artery di sease by Kaplan-Meier cumulative survival curves, univariate Cox regre ssion analyses, and hierarchical stepwise Cox regression analyses, Ove rall, women demonstrated higher resting and peak left ventricular ejec tion fraction response to exercise than men, Ninety-six of 419 patient s (23%) had cardiac events at 5-year follow-up, Although left ventricu lar response to exercise conveyed prognostic information in the combin ed and male populations (multivariate hierarchical analyses chi-square 11, p = 0.001 for delta left ventricular ejection fraction and chi-sq uare 10, p = 0.002 for worsening exercise wall motion score), these va riables were not found to be prognostically useful in women. Women wit h coronary artery disease demonstrated a worsened functional status, e videnced by greater compromise of exercise capacity, despite having le ss extensive anatomic disease than their male counterparts. We conclud e that sex-related differences in left ventricular response to exercis e limit the prognostic utility of exercise ventriculography in women w ith coronary artery disease.