Prognostic value of stress echocardiography in women with high
(
J I Davar, E B Roberts, J G Coghlan, T R Evans, D P Lipkin
Department of
Cardiology, Royal Free Hospital, Pond Street, London NW3 2QG, UK
Correspondence to: Dr Davar josephdavar{at}rfh.nthames.nhs.uk
Submitted 8 November
2000;
Accepted 15 February 2001
OBJECTIVE
To assess the prognostic
significance of stress echocardiography in women with a high
probability of coronary artery disease (CAD).
SETTINGSecondary and tertiary
cardiology unit at a university teaching hospital.
PARTICIPANTSA total of 135 women
(mean (SD) age 63 (9) years) with pre-test probability of CAD 
80%
were selected from a database of patients investigated by treadmill or
dobutamine stress echocardiography between 1995 and 1998.
MAIN OUTCOME MEASURESPatients were
followed up for occurrence of subsequent cardiac events (cardiac death,
myocardial infarction, admission with unstable angina, and
revascularisation) using a structured telephone interview and case note review.
RESULTSEach patient had between
two and seven (mean 3.5) CAD risk factors and pre-test probability of
CAD 80%. Ninety three patients (68.9%) had negative stress
echocardiography. Mean (SD) follow up was 20.1 (8.5) months. There were
six events in the positive stress echocardiography group (two cardiac
deaths, one unstable angina, three revascularisations), and one event
in the negative stress echocardiography group. Cox regression analysis
showed positive stress echocardiography (p=0.02) and age (p=0.03) to be
the only univariate predictors and positive stress echocardiography to
be the only independent predictor of future cardiac events (relative
risk 8.9, confidence interval 1.0 to 76.5, p=0.04). Cumulative event
free survival to 38 months was 98% in the negative stress
echocardiography and 50.7% in the positive stress echocardiography groups.
CONCLUSIONIn women with high
pre-test likelihood of CAD: (1) negative stress echocardiography
identifies a subgroup with low risk of cardiac events who do not
require further invasive investigation and (2) positive stress
echocardiography identifies a subgroup with increased risk of
subsequent cardiac events.
Keywords: coronary artery disease; women; stress echocardiography
© 2001 by The Fellowship of Postgraduate Medicine
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