Key result
Positive DASE in women is linked to ~17-fold greater risk of hard cardiac events.
Why the study?
The prognostic value of dobutamine-atropine stress echocardiography in women with known or suspected coronary artery disease is limited in the literature.
Does dobutamine-atropine stress echocardiography predict cardiac events in women with known or suspected CAD?
Cohort (n=300)
Does dobutamine-atropine stress echocardiography predict cardiac events in women with known or suspected CAD?
Effect estimate: 16.7 times higher chance of events
Absolute Event Rate: 27% vs 94%
p-value: p=0.0003
Dobutamine-atropine stress echocardiography has strong prognostic value for predicting future cardiac events in women with known or suspected CAD.
May support risk stratification in women with suspected CAD; leaves open need for prospective outcome trials.
BACKGROUND: Dobutamine-atropine stress echocardiography (DASE) is a safe and accurate method to diagnose coronary artery disease (CAD), and can identify individuals at high risk for cardiac events such as myocardial infarction and cardiac-related death. The literature is limited regarding the prognostic value of DASE in women. OBJECTIVE: The objective was to determine the prognostic value of DASE in 300 women with known or suspected CAD. RESULTS: The 300 women underwent DASE and were followed up for 65 months (mean: 27 months). Ninety-five women had positive tests and 205 had negative tests. We demonstrated that women with negative tests had a 94% hard-event-free survival rate at follow-up (myocardial infarction and death), and in those with positive tests the event-free survival rate was 27% (P = 0.0003). The difference between women with positive and negative tests was also significant when minor events and total events were considered. Women with positive tests had 16.7 times more chance of having events than women with negative tests. Furthermore, women with positive tests but without cardiac events at follow-up (mean of peak WMSI - rest WMSI = 0.24 +/- 0.16) had less ischemic myocardium than women with positive tests and cardiac events at follow-up (mean of peak WMSI - rest WMSI = 0.34 +/- 0.26)(P < 0.04). CONCLUSION: Dobutamine-atropine stress echocardiography has good prognostic value for cardiac events in women. Women with negative tests have low probability for follow-up infarction or death. Women with positive tests and higher severity of induced ischemia have the highest incidence of cardiac events.
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Cordovil et al. (2004) conducted a cohort in Known or suspected coronary artery disease (n=300). Positive dobutamine-atropine stress echocardiography vs. Negative dobutamine-atropine stress echocardiography was evaluated on Hard-event-free survival (myocardial infarction and death) (16.7 times higher chance of events, p=0.0003). A positive dobutamine-atropine stress echocardiography test in women was associated with a 27% hard-event-free survival rate compared to 94% for a negative test (P=0.0003).
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