Effect of sex on the diagnostic efficacy of dobutamine stress echocardiography with early atropine administration in the detection of coronary artery disease

Abstract

INTRODUCTION: Considering a poorer diagnostic accuracy of exercise stress test in women, echocardiographic stress tests are often recommended for the diagnosis of coronary artery disease (CAD) in this patient group. OBJECTIVES: The aim of the study was to compare the diagnostic value of a modified protocol of dobutamine-atropine stress echocardiography between men and women. PATIENTS AND METHODS: This was a prospective study including 250 patients with symptoms suggesting CAD. Coronary anatomy was examined in 248 subjects, and 1 female patient was excluded owing to coronary anomaly. We analyzed the results of dobutamine stress echocardiography with early atropine administration separately for patients with a history of myocardial infarction (109 women and 138 men; mean age, 62 ±9 years; group A) and patients without such history (72 women and 71 men; mean age, 62 ±9 years; group B). Atropine at a dose of up to 2 mg was administered after dobutamine infusion of 20 μg/kg/min. Coronary luminal stenosis of 50% or more in diameter in the left main coronary artery and of 70% and more in the other arteries was considered significant. RESULTS: In group A, echocardiography had higher specificity and negative predictive value in women compared with men (84.5% vs. 64.4%, P = 0.001, and 92.3% vs. 64.4%, P <0.0001, respectively). The accuracy was 85.3% and 76.8% in women and men, respectively (P = 0.03). In group B, a higher specificity was observed in women compared with men (82.6% vs. 60%, P = 0.01), but the accuracy was similar between the sexes. CONCLUSIONS: Dobutamine stress echocardiography with early atropine administration offers a higher diagnostic value in women, especially with regard to specificity.