Clinical relevance of chest pain during dobutamine stress echocardiographyin women

Background: Dobutamine stress echocardiography (DSE) is commonly used for d iagnosis and management of patients with known or suspected coronary artery disease. Chest pain occurring during DSE potentially provides additional d iagnostic accuracy. Our experience suggests that chest pain occurs frequent ly in women undergoing DSE. Hypothesis: It was the purpose of this study to determine the frequency wit h which chest pain occurs in women undergoing DSE and the relation to induc ible ischemia or coronary artery stenosis. Methods: To determine the prevalence and clinical significance of chest pai n during DSE, we reviewed the records of 154 consecutive women undergoing D SE in our laboratory Of these, 59 patients (37.5%) also underwent coronary angiography The presence or absence of chest pain was correlated with ECG c hanges, left ventricular wall motion abnormalities during DSE, and coronary stenosis by angiography. Results: Forty-one women (26%) developed chest pain during DSE. Patients ex periencing chest pain were older (58.5 +/- 9.3 vs. 54.9 +/- 12.6; p = 0.05) , and had lower resting heart rates (71 +/- 12.2 vs. 77.9 +/- 14.9; p = 0.0 08), but received similar maximum doses of dobutamine and reached comparabl e peak heart rates (131.1 +/- 17.4 vs. 133.5 +/- 21.7; p = NS). Patients wi th chest pain more commonly exhibited ST-segment depression greater than or equal to 1 mm during dobutamine infusion (13/41, 32%, vs. 17/113, 15%; p = 0.02), but chest pain showed no statistically significant correlation with abnormal DSE or with coronary stenosis. Conclusions: In women undergoing DSE, chest pain occurs in 26% and does not appear to be related to inducible myocardial ischemia. Electrocardiographi c changes occur more frequently in patients who experience chest pain, but are also often unrelated to inducible myocardial ischemia.