EXERCISE ECHOCARDIOGRAPHY IS AN ACCURATE AND COST-EFFICIENT TECHNIQUEFOR DETECTION OF CORONARY-ARTERY DISEASE IN WOMEN

Objectives. This study compared the accuracy and cost implications of using exercise echocardiography and exercise electrocardiography for d etection of coronary artery disease in women. Background. The specific ity of exercise electrocardiography in women is lower than in men. Exe rcise echocardiography accurately identifies coronary artery disease i n women, but its utility in place of exercise electrocardiography is u nclear. Methods. One hundred sixty one women without a previous Q wave infarction underwent exercise echocardiography and coronary angiograp hy, Positive findings were a new or worsening wall motion abnormality on the exercise echocardiogram and ST segment depression >0.1 mV at 0. 08 s after the J point on the exercise electrocardiogram (EGG), Result s. Coronary artery stenosis >50% diameter narrowing was present in 59 patients; the sensitivity (mean +/- SD) of exercise echocardiography w as 80 +/- 3%. In 48 patients with an interpretable EGG, the sensitivit y of exercise echocardiography,vas 81 +/- 4%, and that of the exercise ECG was 77 +/- 3% (p = 0.50), In 102 patients without coronary artery disease, the overall specificity of exercise echocardiography was 81 +/- 4%. In 70 patients with an interpretable EGG, the specificity of e xercise echocardiography (80 +/- 3%) exceeded that of the exercise ECG (56 +/- 4%, p < 0.0004). The accuracy of exercise echocardiography wa s also greater than exercise electrocardiography (81 +/- 5% vs. 64 +/- 6%, p < 0.005). Exercise echocardiography stratified significantly mo re patients of intermediate (20% to 80%) pretest disease probability i nto the high (>80%) or low (<20%) posttest probability group. In women without a previous exercise EGG, the specificity of exercise echocard iography continued to exceed that of exercise electrocardiography (80 +/- 3% vs, 64 +/- 3%, p = 0.05). Exercise echocardiography had the bes t balance between accuracy and cost for the diagnosis of coronary arte ry disease in women. Conclusions. Exercise echocardiography is more sp ecific than exercise electrocardiography for diagnosis of coronary art ery disease in women and is a cost-effective approach to the diagnosis of coronary artery disease because of the avoidance of inappropriate angiography.