Dobutamine stress echocardiogrpahy in detecting coronary artery disease and in predicting future cardiac events in females compared to males

The objectives of this study were to determine if Dobutamine stress echocardiography (DSE) was equally effective in detecting coronary artery disease and in predicting future cardiac events in females when compared to males. Out of a total of 1515 consecutive DSE studies, 809 pts were female (mean age, 56 ± 11 yrs) and 706 pts were male (mean age 54 ± 12 yrs). The sensitivity and specificity of DSE in detecting coronary artery disease in a subgroup of 340 pts with coronary angiographic data were 80% and 78% in males and 82%, 74% in females. All pts were followed for cardiac events including death, myocardial infarction, unstable angina, congestive heart failure, cardiac arrhythmias, and revascularization over a period of (mean ± SD, months) 17 ± 9 in females and 19 ± 10 in males. Out of 175 females with DSE positive for ischemia, 53 (30%) had cardiac events, compared to 55 of 208 (26%) males with a positive DSE. Total cardiac events were higher in females (mean of total events 1.8 in females and 1.3 in males, p < 0.01). In pts with a negative DSE, 26 of 634 females (4.1%) had events compared to 41 of 498 males (8.2%) (p<0.05). The overall sensitivity and specificity of DSE for detecting cardiac events were 67% and 83% in females and 57% and 75% in males with higher specificity in females (p<0.001). To assess prognostic value of DSE independent of coronary risk factors, LV dysfunction, and previous myocardial infarction, multivariate Cox regression analysis was used. A positive DSE in females had a risk ratio of 1.5 compared to males. Negative DSE in females has higher specificity in predicting a benign course and a positive DSE is associated with a higher risk of future events when compared to males.