The American Journal of Medicine
Volume 122, Issue 3 , Pages 301-309 , March 2009

Impact of Gender on Risk Stratification by Stress Echocardiography

  • Lauro Cortigiani, MD

      Affiliations

    • Division of Cardiology, Campo di Marte Hospital, Lucca, Italy
  • ,
  • Rosa Sicari, MD

      Affiliations

    • Institute of Clinical Physiology, CNR, Pisa, Italy
    • Corresponding Author InformationRequests for reprints should be addressed to Rosa Sicari, MD, PhD, FESC, CNR Institute of Clinical Physiology, Via G. Moruzzi, 1, 56124 Pisa, Italy
  • ,
  • Riccardo Bigi, MD

      Affiliations

    • Cardiology, Department of Medicine and Surgery, University School of Medicine, Milan, Italy
  • ,
  • Patrizia Landi, BSc

      Affiliations

    • Institute of Clinical Physiology, CNR, Pisa, Italy
  • ,
  • Francesco Bovenzi, MD

      Affiliations

    • Division of Cardiology, Campo di Marte Hospital, Lucca, Italy
  • ,
  • Eugenio Picano, MD

      Affiliations

    • Institute of Clinical Physiology, CNR, Pisa, Italy

References 

  1. American Heart Association. Heart Disease and Stroke Statistics—2007 Update. Dallas, TX: American Heart Association; 2007;
  2. Wenger NK, Shaw LJ, Vaccarino V. Coronary heart disease in women: update 2008. Clin Pharmacol Ther. 2008;83:37–51
  3. Mosca L, Manson JE, Sutherland SE, et al. Cardiovascular disease in women: a statement for healthcare professionals from the American Heart Association. Circulation. 1997;96:2468–2482
  4. Mieres JH, Shaw LJ, Arai A, et al. Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervention, American Heart Association Role of noninvasive testing in the clinical evaluation of women with suspected coronary artery disease: Consensus statement from the Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervention, American Heart Association. Circulation. 2005;111:682–696
  5. Bigi R, Cortigiani L. Stress testing in women: sexual discrimination or equal opportunity?. Eur Heart J. 2005;26:423–425
  6. Kwok Y, Kim C, Grady D, et al. A meta-analysis of exercise testing to detect coronary artery disease in women. Am J Cardiol. 1999;83:660–666
  7. Masini M, Picano E, Lattanzi F, et al. High-dose dipyridamole-echocardiography test in women: correlation with exercise-electrocardiography test and coronary angiography. J Am Coll Cardiol. 1988;12:682–685
  8. Shaw LJ, Miller DD, Romeis JC, et al. Gender differences in the noninvasive evaluation and management of patients with suspected coronary artery disease. Ann Intern Med. 1994;120:559–566
  9. Sawada SG, Ryan T, Fineberg NS, et al. Exercise echocardiographic detection of coronary artery disease in women. J Am Coll Cardiol. 1989;14:1440–1447
  10. Marwick TH, Anderson T, Williams MJ, et al. Exercise echocardiography is an accurate and cost-efficient technique for detection of coronary artery disease in women. J Am Coll Cardiol. 1995;26:335–341
  11. Ho YL, Wu CC, Huang PJ, et al. Assessment of coronary artery disease in women by dobutamine stress echocardiography: comparison with stress thallium-201 single-photon emission computed tomography and exercise electrocardiography. Am Heart J. 1998;135:655–662
  12. Elhendy A, van Domburg RT, Bax JJ, et al. Noninvasive diagnosis of coronary artery disease in women with limited exercise capacity: comparison of dobutamine stress echocardiography and 99mTc sestamibi single-photon emission CT. Chest. 1998;114:1097–1104
  13. Dionisopoulos PN, Collins JD, Smart SC, et al. The value of dobutamine stress echocardiography for the detection of coronary artery disease in women. J Am Soc Echocardiogr. 1997;10:811–817
  14. Heupler S, Metha R, Lobo A, et al. Prognostic implications of exercise echocardiography in women with known or suspected coronary artery disease. J Am Coll Cardiol. 1997;30:414–420
  15. Cortigiani L, Dodi C, Paolini EA, et al. Prognostic value of pharmacological stress echocardiography in women with chest pain and unknown coronary artery disease. J Am Coll Cardiol. 1998;32:1975–1981
  16. Davar JI, Brull DJ, Bulugahipitiya S, et al. Prognostic value of negative dobutamine stress echo in women with intermediate probability of coronary artery disease. Am J Cardiol. 1999;83:100–102
  17. Dodi C, Cortigiani L, Masini M, et al. The incremental prognostic value of pharmacological stress echo over exercise electrocardiography in women with chest pain of unknown origin. Eur Heart J. 2001;22:145–152
  18. Cortigiani L, Gigli G, Vallebona A, et al. The stress echo prognostic gender gap. Eur J Echocardiogr. 2001;2:132–138
  19. Arruda-Olson AM, Juracan EM, Mahoney DW, et al. Prognostic value of exercise echocardiography in 5,798 patients: is there a gender difference?. J Am Coll Cardiol. 2002;39:625–631
  20. Shaw LJ, Vassey C, Sawada S, et al. Impact of gender on risk stratification by exercise and dobutamine stress echocardiography: long-term mortality in 4,234 women and 6,898 men. Eur Heart J. 2005;26:447–456
  21. Biagini E, Elhendy A, Bax JJ, et al. Seven-year follow-up after dobutamine stress echocardiography (Impact of gender on prognosis). J Am Coll Cardiol. 2005;45:93–97
  22. Picano E, Landi P, Bolognese L, et al. Prognostic value of dipyridamole echocardiography early after uncomplicated myocardial infarction: a large scale multicenter trial. Am J Med. 1993;11:608–618
  23. World Health Organization. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Report of a WHO Consultation. Part I: Diagnosis and Classification of Diabetes Mellitus. WHO/NCD/NCS/99.2. Geneva: World Health Organization; 1999;
  24. European Society of Hypertension–European Society of Cardiology. Guidelines for the management of arterial hypertension. J Hypertension. 2003;21:1011–1053
  25. National cholesterol education program expert panel. Third Report of the Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Full Report. World Wide Web; 2001. Available at http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm. Last accessed January 10, 2009.
  26. Sicari R, Nihoyannopoulos P, Evangelista A, et al. Stress echocardiography expert consensus statement from the European Association of Echocardiography. Eur J Echocardiogr. 2008;9:415–437
  27. Lauer MS, Blackstone EH, Young JB, Topol EJ. Cause of death in clinical research: time for a reassessment?. J Am Coll Cardiol. 1999;34:618–620
  28. Pencina MJ, D'Agostino RB, D'Agostino RB, Vasan RS. Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Stat Med. 2008;27:157–172
  29. Daly CA, De Stavola B, Sendon JL, et al. Euro Heart Survey Investigators Predicting prognosis in stable angina—results from the Euro heart survey of stable angina: prospective observational study. BMJ. 2006;332:262–267
  30. Greenland P, Reicher-Reiss H, Goldbourt U, Behar S Israeli SPRINT Investigators. In-hospital and 1-year mortality in 1,524 women after myocardial infarction: comparison with 4,315 men. Circulation. 1991;83:484–491
  31. Hochman JS, Tamis JE, Thompson TD, et al. Sex, clinical presentation, and outcome in patients with acute coronary syndromes. N Engl J Med. 1999;341:226–232
  32. Shaw LJ, Bairey Merz CN, Pepine CJ, et al. WISE Investigators Insights from the NHLBI-Sponsored Women's Ischemia Syndrome Evaluation (WISE) Study: Part I: gender differences in traditional and novel risk factors, symptom evaluation, and gender-optimized diagnostic strategies. J Am Coll Cardiol. 2006;47(3 Suppl):S4–S20
  33. Hochman JS, Tamis-Holland JE. Acute coronary syndromes: does sex matter?. JAMA. 2002;288:3161–3164
  34. Glaser R, Herrmann HC, Murphy SA, et al. Benefit of an early invasive management strategy in women with acute coronary syndromes. JAMA. 2002;288:3124–3129
  35. Picano E, Molnaro S, Pasanisi E. The diagnostic accuracy of pharmacological stress echocardiography for the assessment of coronary artery disease: a meta-analysis. Cardiovasc Ultrasound. 2008;6:30
  36. Gershlick AH, de Belder M, Chambers J, et al. Role of non-invasive imaging in the management of coronary artery disease: an assessment of likely change over the next 10 years (A report from the British Cardiovascular Society Working Group). Heart. 2007;93:423–431
  37. Pingitore A, Picano E, Varga A, et al. Prognostic value of pharmacological stress echocardiography in patients with known or suspected coronary artery disease: a prospective, large-scale, multicenter, head-to-head comparison between dipyridamole and dobutamine test. J Am Coll Cardiol. 1999;34:1769–1777
  38. Schroeder K, Wieckhorst A, Voller H. Comparison of the prognostic value of dipyridamole and dobutamine stress echocardiography in patients with known or suspected coronary artery disease. Am J Cardiol. 1997;79:1516–1517
  39. Minardi G, Disegni M, Manzara C, et al. Diagnostic and prognostic value of dipyridamole and dobutamine stress echocardiography in patients with acute myocardial infarction. Am J Cardiol. 1997;80:847–851
  40. Cortigiani L, Bigi R, Sicari R, et al. Prognostic value of pharmacological stress echocardiography in diabetic and nondiabetic patients with known or suspected coronary artery disease. J Am Coll Cardiol. 2006;47:605–610

 Funding: Financial support for the present study was received from institutional funding of the CNR, Institute of Clinical Physiology, Pisa, Italy.

 Conflict of Interest: None of the authors have any conflicts of interest associated with the work presented in this manuscript.

 Authorship: All authors had access to the data and played a role in writing this manuscript.

PII: S0002-9343(08)01120-0

doi: 10.1016/j.amjmed.2008.11.003

The American Journal of Medicine
Volume 122, Issue 3 , Pages 301-309 , March 2009