J Cardiovasc Ultrasound.  2016 Jun;24(2):135-143. 10.4250/jcu.2016.24.2.135.

Head to Head Comparison of Stress Echocardiography with Exercise Electrocardiography for the Detection of Coronary Artery Stenosis in Women

• Kim MN
• Kim SA
• Kim YH
• Hong SJ
• Park SM
• Shin MS
• Kim MA
• Hong KS
• Shin GJ
• Shim WJ

• KMID: 2308703
• DOI: http://doi.org/10.4250/jcu.2016.24.2.135

Abstract

BACKGROUND
Exercise-stress electrocardiography (ECG) is initially recommended for the diagnosis of coronary artery disease. But its value has been questioned in women because of suboptimal diagnostic accuracy. Stress echocardiography had been reported to have comparable test accuracy in women. But the data comparing the diagnostic accuracy of exercise-stress ECG and stress echocardiography directly are few. The aim of the study was to compare the diagnostic accuracy of exercise-stress ECG and dobutamine stress echocardiography (DSE) in Korean women.
METHODS
202 consecutive female patients who presented with chest pain in outpatient clinic, and who underwent treadmill exercise test (TET), DSE and coronary angiography were included for the study. The diagnostic accuracy TET and DSE were calculated by the definition of > 50% or > 75% coronary artery stenosis (CAS).
RESULTS
The sensitivity and specificity were higher with DSE (70.4, 94.6%) than TET (53.7, 73.6%) for detection of > 50% CAS. The higher accuracy of DSE was maintained after exclusion of the patients who could not achieve over 85% age predicted heart rate before ischemia induction. DSE also showed greater diagnostic accuracy than TET by > 75% CAS criteria, and in subsets of patient with intermediate pretest probability.
CONCLUSION
In the diagnosis of CAS, DSE showed higher accuracy than TET in female patients who presented with chest pain. As well as the test accuracy, adequate stress was more feasible with DSE than TET. These finding suggests DSE may be used as the first-line diagnostic tool in the detection of CAS in women with chest pain.

Keyword

Dobutamine stress echocardiography; Exercise-stress electrocardiography; Coronary artery disease; Women

MeSH Terms

Ambulatory Care Facilities
Chest Pain
Coronary Angiography
Coronary Artery Disease
Coronary Stenosis*
Coronary Vessels*
Diagnosis
Echocardiography, Stress*
Electrocardiography*
Exercise Test
Female
Head*
Heart Rate
Humans
Ischemia
Sensitivity and Specificity

Figure

• 

  Fig. 1 The comparison of predictive values between DSE, TET, and DTS for prediction of CAS, and multi-vessel CAS in whole study population by ROC curve analysis. A: The comparison of ROC curves for prediction of CAS. B: The comparison of ROC curves for prediction of multi-vessel CAS. *p < 0.001 between TET and DSE, †p = 0.002 between DSE and DTS, ‡p < 0.001 between TET and DSE, §p = 0.003 between DSE and DTS. DSE: dobutamine stress echocardiography, TET: treadmill exercise test, DTS: Duke treadmill score, CAS: coronary artery stenosis, ROC: receiver operating characteristic.

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