Dobutamine stress echocardiography in the diagnosis of coronary artery disease in women with chest pain: comparison with different noninvasive tests.

Background: Diagnosis of coronary artery disease(CAD) in women remains elusive. The classical diagnostic armamentarium has been found to be very limited. Dobutamine stress echocardiography has emerged as a powerful test in assessing CAD in the general population, but most studies failed to include women.

Hypothesis: The accuracy of dobutamine stress echocardiography in the diagnosis of CAD in women with chest pain is high and superior to dipyridamole echocardiography, exercise electrocardiography, and sestamibi single-photon emission tomography (MIBI-SPECT) scintigraphy.

Methods: We studied 99 consecutive women with chest pain and no previous history of CAD who underwent dobutamine echocardiography and coronary angiography. We also compared these results with those of dipyridamole echocardiography in 63 patients. exercise stress testing in 83 (48 conclusive), and MIBI-SPECT scintigraphy during dobutamine infusion in 54.

Results: Significant CAD was found in 42 women. Sensitivity and specificity of dobutamine stress echocardiography were 69 and 89%, respectively. Dipyridamole echocardiography showed similar accuracy (sensitivity 72% and specificity 94%). Finally, sensitivity of exercise test and MIBI-SPECT was similar (76 and 88%, respectively) and specificity was lower (53 and 57%, respectively). After excluding patients known to have a high incidence of false positive results, MIBI-SPECT specificity rose up to 80%.

Conclusion: Dobutamine stress echocardiography and dipyridamole echocardiography bear a high diagnostic accuracy in women with chest pain. MIBI-SPECT is also a useful tool after excluding subgroups with a high incidence of false positive results.