Dobutamine stress echocardiography in women with chest pain - Pilot phase data from the National Heart, Lung and Blood Institute Women's Ischemia Syndrome Evaluation (WISE)

OBJECTIVES The aim of this project was to assess the utility of dobutamine stress echo cardiography (DSE) for evaluation of women with suspected ischemic heart di sease. BACKGROUND Most investigations addressing efficacy of diagnosis and treatment of coron ary artery disease (CAD) have been performed in predominantly male populati ons. As part of the Women's Ischemia Syndrome Evaluation (WISE) study, DSE was assessed in women participating at the University of Florida clinical s ite. METHODS Women with chest pain or other symptoms suggestive of myocardial ischemia a nd clinically indicated coronary angiography were eligible for the WISE stu dy. Enrolled subjects underwent DSE using a modified protocol. Coronary ste nosis was assessed by core laboratory quantitative coronary angiography (QC A). RESULTS The 92 women studied ranged in age from 34 to 82 years (mean 57.5). All wom en had greater than or equal to 1 major risk for CAD, and most (89, 97%) ha d greater than or equal to 2 risk factors. In 78 women (85%), left ventricu lar wall motion was normal at baseline and during peak infusion. The remain ing 14 women had wall motion abnormalities during DSE. By QCA, 25 women (27 %) had greater than or equal to 50% coronary stenosis, including 10 with si ngle-vessel obstruction. Dobutamine stress echocardiopraphy was abnormal in 10:of these 25 women, yielding overall sensitivity of 40%, and 60% for mul tivessel stenosis. Exclusion of women with inadequate heart rate response y ielded overall sensitivity of 50%, and 81.8% for multivessel stenosis. Dobu tamine stress echocardiography was normal in 54 of the 67 women with <50% c oronary narrowing, specificity 80.6%. CONCLUSIONS Dobutamine stress echocardiography reliably detects multivessel stenosis in women with suspected CAD. However, DSE is usually negative in women with s ingle-vessel stenosis, and in the larger subset without coronary stenosis. Ongoing protocols of the WISE study are expected to improve diagnostic accu racy in women with single-vessel disease, as well as provide important data in the substantial number of women with chest pain but without epicardial coronary artery stenosis. (C) 1999 by the American College of Cardiology.