GENDER DIFFERENCES IN THE ACCURACY OF DOBUTAMINE STRESS ECHOCARDIOGRAPHY FOR THE DIAGNOSIS OF CORONARY-ARTERY DISEASE

The accuracy of dobutamine stress echocardiography (DSE) for the diagn osis of coronary artery disease (CAD) has not been yet evaluated in wo men. We studied the effect of gender on the accuracy of DSE for the di agnosis of CAD in 306 consecutive patients (210 men and 96 women) with limited exercise capacity and suspected myocardial ischemia who under went coronary angiography within 3 months of DSE. There were no seriou s complications during DSE. Men had a higher prevalence of nonsustaine d 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 (greater than or equal to 50% luminal diameter stenosis) was present in 171 men (81 %) and in 62 women (65%, <0.005). The sensitivity, specificity, and ac curacy 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), a nd 74% (CI 68 to 80) in men, respectively. Overall specificity was hig her in women than in men (p <0.05), Regional accuracy of DSE was signi ficantly higher in women than in men in the 3 arterial regions (84% [C I 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 o verall specificity and the regional accuracy of DSE are higher in wome n than in men. Further studies are required to evaluate the functional significance of these findings and their reproducibility in different patient populations. (C) 1997 by Excerpta Medica, Inc.