909-3 Transesophageal Dobutamine Stress Echocardiography for Detection of Coronary Artery Disease in Women Presenting with Chest Pain: Comparison with Other Standard Tests

Abstract

Non-invasive identification of coronary artery disease (CAD) in women is hindered by a relatively high incidence of false positive studies. We have shown that transesophageal dobutamine stress echocardiography (TEDSE) is a useful technique for assessment of CAD in a predominantely male population. To determine the accuracy of TEDSE for detection of CAD in women in relation to other standard non-invasive tests, we studied 49 women (age 51 ± 10 years, range 33–78) who underwent cardiac catheterization, exercise treadmill test (ETT) and stress thallium scintigraphy (TI) for evaluation of chest pain and suspected CAD. Transesophageal echocardiography was performed using a biplane (13 patients) or an omniplane probe (36 patients), and dobutamine was infused in stepwise increments up to 40 μg/kg/min. Ten women had CAD (≥ 70% stenosis of ≥ 1 major coronary artery) and 39 had normal coronary angiograms. During TEDSE, chest pain developed in 8 of 10 (80%) women with CAD and in 31 of the 39 (79%) with normal coronary arteries (p = NS). Of the 10 women with CAD, 7 had ST segment depression during ETT, 8 had reversible TI defects, and 8 developed new or worsening wall motion abnormalities during TEDSE (sensitivity: 70%, 80%, and 80%, respectively; p = NS). Of the 39 women without CAD, 12 had ST segment depression during ETT, 8 had reversible Tl defects, and none developed new or worsening wall motion abnormalities during TEDSE (specificity: 69%,79%, and 100%, respectively; p < 0.002). The overall accuracy was 69% for ETT, 80% for TI, and 96% for TEDSE (p < 0.003). Thus, TEDSE is an accurate test for detection of CAD among women presenting with chest pain which, by virtue of its high specificity, compares favorably with other standard methods.