European Heart Journal Advance Access originally published online on February 1, 2005
European Heart Journal 2005 26(5):447-456; doi:10.1093/eurheartj/ehi102
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Impact of gender on risk stratification by exercise and dobutamine stress echocardiography: long-term mortality in 4234 women and 6898 men
1Cardiovascular Research Institute, 5665 Peachtree Dunwoody Road, Atlanta, GA, USA
2Asheville Cardiology Associates, Asheville, NC, USA
3Indiana University, Indianapolis, IN, USA
4Cleveland Clinic Foundation, Cleveland, OH, USA
5Department of Medicine, University of Queensland, Brisbane, Australia
Received 19 January 2004; revised 23 November 2004; accepted 30 November 2004; online publish-ahead-of-print 1 February 2005.
* Corresponding author. Tel: +1 404 229 7339; fax: +1 404 875 6086. E-mail address: lshaw{at}acrionline.org
See page 423 for the editorial comment on this article (doi:10.1093/eurheartj/ehi129)
Aims Prior research is limited with regard to the diagnostic and prognostic accuracy of commonplace cardiac imaging modalities in women. The aim of this study was to examine 5-year mortality in 4234 women and 6898 men undergoing exercise or dobutamine stress echocardiography at three hospitals.
Methods and results Univariable and multivariable Cox proportional hazards models were used to estimate time to cardiac death in this multi-centre, observational registry. Of the 11 132 patients, women had a greater frequency of cardiac risk factors (P<0.0001). However, men more often had a history of coronary disease including a greater frequency of echocardiographic wall motion abnormalities (P<0.0001). During 5 years of follow-up, 103 women and 226 men died from ischaemic heart disease (P<0.0001). Echocardiographic estimates of left ventricular function (P<0.0001) and the extent of ischaemic wall motion abnormalities (P<0.0001) were highly predictive of cardiac death. Risk-adjusted 5-year survival was 99.4, 97.6, and 95% for exercising women with no, single, and multi-vessel ischaemia (P<0.0001). For women undergoing dobutamine stress, 5-year survival was 95, 89, and 86.6% for those with 0, 1, and 2–3 vessel ischaemia (P<0.0001). Exercising men had a 2.0-fold higher risk at every level of worsening ischaemia (P<0.0001). Significantly worsening cardiac survival was noted for the 1568 men undergoing dobutamine stress echocardiography (P<0.0001); no ischaemia was associated with 92% 5-year survival as compared with death rates of 
16% for men with ischaemia on dobutamine stress echocardiography (P<0.0001).
Conclusion Echocardiographic measures of inducible wall motion abnormalities and global and regional left ventricular function are highly predictive of long-term outcome for women and men alike.
Key Words: Prognosis • Gender • Echocardiography • Ventricular function • Exercise testing
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