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European Heart Journal Advance Access published online on February 1, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi102
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved

Clinical research

Impact of gender on risk stratification by exercise and dobutamine stress echocardiography: long-term mortality in 4234 women and 6898 men

Leslee J. Shaw 1*, Charles Vasey 2, Stephen Sawada 3, Curt Rimmerman 4, and Thomas H. Marwick 5

1 Cardiovascular Research Institute, 5665 Peachtree Dunwoody Road, Atlanta, GA, USA
2 Asheville Cardiology Associates, Asheville, NC, USA
3 Indiana University, Indianapolis, IN, USA
4 Cleveland Clinic Foundation, Cleveland, OH, USA
5 Department of Medicine, University of Queensland, Brisbane, Australia

* To whom correspondence should be addressed.
Leslee J. Shaw, E-mail: lshaw{at}acrionline.org


  Abstract

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.

Keywords: Prognosis; Gender; Echocardiography; Ventricular function; Exercise testing.
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