Value and limitations of dobutamine stress echocardiography in women with suspected coronary artery disease

Abstract

The accuracy of exercise electrocardiography (ECG) for detecting coronary artery disease (CAD) in women is limited. Dobutamine stress echocardiography (DSE) is an alternative. Limited and conflicting data exist on the utility of DSE. This prospective study determines value and limitations of DSE compared with exercise ECG in women with suspected CAD. A total of 114 consecutive women without previous myocardial infarction underwent standard exercise ECG and DSE prior to coronary angiography performed within 5±2 days. Pretest probability of CAD was calculated from clinical parameters and significant CAD was defined as ≥50% coronary artery luminal narrowing. Prevalence of CAD was 39.5% with multivessel disease in 49%. Most patients had a low or intermediate pretest probability of CAD (75%). Exercise ECG recordings were diagnostic in 71% and DSE in 90% of women. Overall sensitivity, specificity and accuracy for DSE were superior to exercise ECG (80%, 81%, and 80%, respectively, versus 65%, 55%, and 59%, respectively; p<0.05). Accuracy of DSE was increased in multivessel disease (85%), good echocardiographic image quality (86%) compared to single vessel disease (73%) and moderate image quality (69%). Accuracy of DSE demonstrated little differences in subgroups of pretest probability (78–85%), whereas accuracy of exercise ECG ranged from 44% to 71%. DSE is superior to exercise ECG in the evaluation of suspected CAD in women. Accuracy of ST-segment analysis in exercise ECG remains questionable for the investigation of myocardial ischemia in women and may be supplemented or substituted by DSE.