Seven-year follow-up after dobutamine stress echocardiography: Impact of gender on prognosis

Elena Biagini, Abdou Elhendy, Jeroen J. Bax, Vittoria Rizzello, Arend F.L. Schinkel, Ron T. Van Domburg, Miklos D. Kertai, Boudewijn J. Krenning, Manolis Bountioukos, Claudio Rapezzi, Angelo Branzi, Maarten L. Simoons, Don Poldermans

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Abstract

The aim of this study was to investigate the effects of gender on long-term prognosis of patients undergoing dobutamine stress echocardiography (DSE). Gender differences in the predictors of outcome among patients with known or suspected coronary artery disease undergoing DSE have not been adequately studied. We studied 2,276 men and 1,105 women with known or suspected coronary artery disease who underwent DSE. Follow-up events were cardiac death and nonfatal myocardial infarction (MI). Dobutamine stress echocardiography was normal in 687 men (30%) and 483 women (44%) (p < 0.0001). Ischemia on DSE was present in 1,194 men (52%) and 416 women (38%) (p < 0.001). During a mean follow-up of 7 ± 3.4 years, there were 894 (26%) deaths (442 attributed to cardiac causes) and 145 (4%) nonfatal MIs. The annual cardiac event rate was 2.5% in men and 1.2% in women with normal DSE. Independent predictors of cardiac events in patients with normal DSE using a Cox proportional hazards regression analysis were male gender (hazard ratio [HR]: 1.7 [range 1.1 to 2.8]), age (HR: 1.02 [range 1.01 to 1.04]), history of heart failure (HR: 3.4 [range 1.5 to 7.9]), previous MI (HR: 1.7 [range 1.1 to 2.8]), and diabetes (HR: 2.4 [range 1.3 to 4.5]). Independent predictors of cardiac events in patients with an abnormal DSE were age (HR: 1.03 [range 1.02 to 1.04]), history of heart failure (HR: 1.7 [range 1.3 to 2.1]), diabetes (HR: 1.4 [range 1.1 to 1.8]), heart rate at rest (HR: 2.8 [range 1.4 to 5.8]), wall motion abnormalities at rest (HR: 1.06 [range 1.04 to 1.09]), and ischemia on DSE (HR: 1.04 [range 1.02 to 1.07]). Myocardial ischemia was an independent predictor of cardiac events in both men and women. Dobutamine stress echocardiography provides independent prognostic information in both men and women. In patients with normal DSE, gender is independently associated with cardiac events. The outcome of patients with abnormal DSE is not related to gender, after adjusting for stress echocardiographic abnormalities.

Original languageEnglish
Pages (from-to)93-97
Number of pages5
JournalJournal of the American College of Cardiology
Volume45
Issue number1
DOIs
Publication statusPublished - jan. 4 2005

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Biagini, E., Elhendy, A., Bax, J. J., Rizzello, V., Schinkel, A. F. L., Van Domburg, R. T., Kertai, M. D., Krenning, B. J., Bountioukos, M., Rapezzi, C., Branzi, A., Simoons, M. L., & Poldermans, D. (2005). Seven-year follow-up after dobutamine stress echocardiography: Impact of gender on prognosis. Journal of the American College of Cardiology, 45(1), 93-97. https://doi.org/10.1016/j.jacc.2004.09.048