CLINICAL STUDIES
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)
Jannet F. Lewis, MD, FACC*,
Lang Lin, MD*,
Susan McGorray, PhD*,
Carl J. Pepine, MD, FACC*,
Mark Doyle, MD ,
Daniel Edmundowicz, MD ,
Richard Holubkov, PhD ,
Gerald Pohost, MD, FACC,
Nathaniel Reichek, MD, FACC||,
William Rogers, MD, FACC,
Barry L. Sharaf, MD, FACC**,
George Sopko, MD¶ and
C. Noel Bairey Merz, MD, FACC#
* Division of Cardiology, University of Florida, Gainesville, Florida, USA
Division of Cardiology, University of Alabama, Birmingham, Alabama, USA
Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
WISE Coordinating Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
|| Division of Cardiology, Allegheny University Health Centers, Pittsburgh, Pennsylvania, USA
¶ National Heart, Lung and Blood Institutes, Bethesda, Maryland, USA
# Cedar Sinai Medical Center, Los Angeles, California, USA
** Brown University, Providence, Rhode Island, USA
Manuscript received June 26, 1998;
revised manuscript received December 3, 1998,
accepted January 20, 1999.
Reprint requests and correspondence: Dr. Jannet F. Lewis, c/o WISE Coordinating Center, University of Pittsburgh, 127 Parran Hall, 130 DeSoto St., Pittsburgh, Pennsylvania 15261
OBJECTIVES
The aim of this project was to assess the utility of dobutamine stress echocardiography (DSE) for evaluation of women with suspected ischemic heart disease.
BACKGROUND
Most investigations addressing efficacy of diagnosis and treatment of coronary artery disease (CAD) have been performed in predominantly male populations. As part of the Women’s Ischemia Syndrome Evaluation (WISE) study, DSE was assessed in women participating at the University of Florida clinical site.
METHODS
Women with chest pain or other symptoms suggestive of myocardial ischemia and clinically indicated coronary angiography were eligible for the WISE study. Enrolled subjects underwent DSE using a modified protocol. Coronary stenosis was assessed by core laboratory quantitative coronary angiography (QCA).
RESULTS
The 92 women studied ranged in age from 34 to 82 years (mean 57.5). All women had  1 major risk for CAD, and most (89, 97%) had 2 risk factors. In 78 women (85%), left ventricular wall motion was normal at baseline and during peak infusion. The remaining 14 women had wall motion abnormalities during DSE. By QCA, 25 women (27%) had 50% coronary stenosis, including 10 with single-vessel obstruction. Dobutamine stress echocardiography was abnormal in 10 of these 25 women, yielding overall sensitivity of 40%, and 60% for multivessel stenosis. Exclusion of women with inadequate heart rate response yielded overall sensitivity of 50%, and 81.8% for multivessel stenosis. Dobutamine stress echocardiography was normal in 54 of the 67 women with <50% coronary 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 single-vessel stenosis, and in the larger subset without coronary stenosis. Ongoing protocols of the WISE study are expected to improve diagnostic accuracy 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.
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Abbreviations and Acronyms
| | ANGIO | = coronary angiography/angiographic | | CAD | = coronary artery disease | | DSE | = dobutamine stress echocardiography | | ECG | = electrocardiogram | | ETT | = exercise treadmill stress testing | | WISE | = Women’s Ischemia Syndrome Evaluation |
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