Effect of sex on the diagnostic efficacy of dobutamine stress echocardiography with early atropine administration in the detection of coronary artery disease

INTRODUCTION Considering a poorer diagnostic accuracy of exercise stress test in women, echocardiographic stress tests are often recommended for the diagnosis of coronary artery disease (CAD) in this patient group.
OBJECTIVES The aim of the study was to compare the diagnostic value of a modified protocol of dobutamine‑atropine stress echocardiography between men and women.
PATIENTS AND METHODS This was a prospective study including 250 patients with symptoms suggesting CAD. Coronary anatomy was examined in 248 subjects, and 1 female patient was excluded owing to coronary anomaly. We analyzed the results of dobutamine stress echocardiography with early atropine administration separately for patients with a history of myocardial infarction (109 women and 138 men; mean age, 62 ±9 years; group A) and patients without such history (72 women and 71 men; mean age, 62 ±9 years; group B). Atropine at a dose of up to 2 mg was administered after dobutamine infusion of 20 μg/kg/min. Coronary luminal stenosis of 50% or more in diameter in the left main coronary artery and of 70% and more in the other arteries was considered significant.
RESULTS In group A, echocardiography had higher specificity and negative predictive value in women compared with men (84.5% vs. 64.4%, P = 0.001, and 92.3% vs. 64.4%, P <0.0001, respectively). The accuracy was 85.3% and 76.8% in women and men, respectively (P = 0.03). In group B, a higher specificity was observed in women compared with men (82.6% vs. 60%, P = 0.01), but the accuracy was similar between the sexes.
CONCLUSIONS Dobutamine stress echocardiography with early atropine administration offers a higher diagnostic value in women, especially with regard to specificity.