CLINICAL RESEARCH: ECHOCARDIOGRAPHY
Seven-year follow-up after dobutamine stress echocardiography
Impact of gender on prognosis
Elena Biagini, MD*, ,
Abdou Elhendy, MD, FACC ,
Jeroen J. Bax, MD ,
Vittoria Rizzello, MD*,
Arend F.L. Schinkel, MD*,
Ron T. van Domburg, PhD*,
Miklos D. Kertai, MD*,
Boudewijn J. Krenning, MD*,
Manolis Bountioukos, MD*,
Claudio Rapezzi, MD,
Angelo Branzi, MD,
Maarten L. Simoons, MD, FACC* and
Don Poldermans, MD*,*
* *Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands
Institute of Cardiology, S. Orsola Hospital, Bologna, Italy
University of Nebraska Medical Center, Omaha, Nebraska
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
Manuscript received July 15, 2004;
revised manuscript received September 14, 2004,
accepted September 16, 2004.
* Reprint requests and correspondence: Dr. Don Poldermans, Department of Cardiology, Thoraxcenter Room Ba 300, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
(Email: d.poldermans{at}erasmusmc.nl).
OBJECTIVES: The aim of this study was to investigate the effects of gender on long-term prognosis of patients undergoing dobutamine stress echocardiography (DSE).
BACKGROUND: Gender differences in the predictors of outcome among patients with known or suspected coronary artery disease undergoing DSE have not been adequately studied.
METHODS: We studied 2,276 men and 1,105 women with known or suspected coronary artery disease who underwent DSE. Follow-up events were cardiac death and nonfatal myocardial infarction (MI).
RESULTS: Dobutamine stress echocardiography was normal in 687 men (30%) and 483 women (44%) (p < 0.0001). Ischemia on DSE was present in 1,194 men (52%) and 416 women (38%) (p < 0.001). During a mean follow-up of 7 ± 3.4 years, there were 894 (26%) deaths (442 attributed to cardiac causes) and 145 (4%) nonfatal MIs. The annual cardiac event rate was 2.5% in men and 1.2% in women with normal DSE. Independent predictors of cardiac events in patients with normal DSE using a Cox proportional hazards regression analysis were male gender (hazard ratio [HR]: 1.7 [range 1.1 to 2.8]), age (HR: 1.02 [range 1.01 to 1.04]), history of heart failure (HR: 3.4 [range 1.5 to 7.9]), previous MI (HR: 1.7 [range 1.1 to 2.8]), and diabetes (HR: 2.4 [range 1.3 to 4.5]). Independent predictors of cardiac events in patients with an abnormal DSE were age (HR: 1.03 [range 1.02 to 1.04]), history of heart failure (HR: 1.7 [range 1.3 to 2.1]), diabetes (HR: 1.4 [range 1.1 to 1.8]), heart rate at rest (HR: 2.8 [range 1.4 to 5.8]), wall motion abnormalities at rest (HR: 1.06 [range 1.04 to 1.09]), and ischemia on DSE (HR: 1.04 [range 1.02 to 1.07]). Myocardial ischemia was an independent predictor of cardiac events in both men and women.
CONCLUSIONS: Dobutamine stress echocardiography provides independent prognostic information in both men and women. In patients with normal DSE, gender is independently associated with cardiac events. The outcome of patients with abnormal DSE is not related to gender, after adjusting for stress echocardiographic abnormalities.
|
Abbreviations and Acronyms
| | CAD = coronary artery disease | | DSE = dobutamine stress echocardiography | | HR = hazard ratio | | MI = myocardial infarction |
|
This article has been cited by other articles:
|
|
|
|
 
R. Sicari, P. Nihoyannopoulos, A. Evangelista, J. Kasprzak, P. Lancellotti, D. Poldermans, J.-U. Voigt, J. L. Zamorano, and on behalf of the European Association of Echocardi
Stress echocardiography expert consensus statement: European Association of Echocardiography (EAE) (a registered branch of the ESC)
Eur J Echocardiogr,
July 1, 2008;
9(4):
415 - 437.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
O. Seda, J. Tremblay, D. Gaudet, P.-L. Brunelle, A. Gurau, E. Merlo, L. Pilote, S. N. Orlov, F. Boulva, M. Petrovich, et al.
Systematic, Genome-Wide, Sex-Specific Linkage of Cardiovascular Traits in French Canadians
Hypertension,
April 1, 2008;
51(4):
1156 - 1162.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. B. Ingul, E. Rozis, S. A. Slordahl, and T. H. Marwick
Incremental Value of Strain Rate Imaging to Wall Motion Analysis for Prediction of Outcome in Patients Undergoing Dobutamine Stress Echocardiography
Circulation,
March 13, 2007;
115(10):
1252 - 1259.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Chaowalit, R. B. McCully, M. J. Callahan, F. Mookadam, K. R. Bailey, and P. A. Pellikka
Outcomes after normal dobutamine stress echocardiography and predictors of adverse events: long-term follow-up of 3014 patients
Eur. Heart J.,
December 2, 2006;
27(24):
3039 - 3044.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. I. Qureshi, M. F. K. Suri, J. Zhou, and A. A. Divani
African American women have poor long-term survival following ischemic stroke.
Neurology,
November 14, 2006;
67(9):
1623 - 1629.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Elhendy, S. Chapman, T. R. Porter, and J. Windle
Association of Myocardial Ischemia With Mortality and Implantable Cardioverter-Defibrillator Therapy in Patients With Coronary Artery Disease at Risk of Arrhythmic Death
J. Am. Coll. Cardiol.,
November 1, 2005;
46(9):
1721 - 1726.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Biagini, A. Elhendy, A. F.L. Schinkel, S. Nelwan, V. Rizzello, R. T. van Domburg, C. Rapezzi, G. Rocchi, M. L. Simoons, J. J. Bax, et al.
Prognostic Significance of Left Anterior Hemiblock in Patients With Suspected Coronary Artery Disease
J. Am. Coll. Cardiol.,
September 6, 2005;
46(5):
858 - 863.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M. Tsutsui, A. Elhendy, J. R. Anderson, F. Xie, A. C. McGrain, and T. R. Porter
Prognostic Value of Dobutamine Stress Myocardial Contrast Perfusion Echocardiography
Circulation,
September 6, 2005;
112(10):
1444 - 1450.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
