Influence of gender on the diagnostic and prognostic significance of the dobutamine stress echocardiography for ischemia
Abstract
Uvod/Cilj. Kardiovaskularne bolesti su najčešći uzrok mortaliteta i morbiditeta u celom svetu, sa najvećom incidencijom u zemljama sa niskim i srednjim dohotkom. Dobutaminski stres-ehokardiografski (DSE) test ima značajnu ulogu u dijagnostici koronarne arterijske bolesti. Cilj rada bio je da se ispita uticaj pola na tačnost DSE, kao i na prognostički značaj skora indeksa pokretljivosti zidova (wall motion score index – WMSI) leve komore, kao parametra DSE za neželjene kardiovaskularne događaje (NKD). Metode. Prospektivnom, opservacionom studijom koja je rađena na Klinici za kardiovaskularne bolesti Univerzitetskog kliničkog centra Republike Srpske, Bosna i Hercegovina, obuhvaćena su 143 bolesnika koji su zbog sumnje na koronarnu bolest bili podvrgnuti DSE u periodu od 1. januara 2021. do 1. februara 2022. godine. Godinu dana od urađenog DSE testa, uočeni su sledeći NKD: nestabilna angina pektoris, akutni infarkt miokarda, perkutana koronarna intervencija, restenoza u stentu (in-stent restenosis), aortokoronarni bypass, srčana insuficijencija i smrt. Rezultati. Pozitivan DSE test bio je češći kod muškaraca (45%) u odnosu na žene (25%), što je bilo statistički značajno (p < 0,05). Senzitivnost testa kod muškaraca iznosila je 96,0%, a specifičnost 93,9%. Kod žena su i senzitivnost i specifičnost iznosile 86,7%. NKD su bili češći kod muškaraca (43%) nego kod žena (19%) i ta razlika je bila statistički značajna (p < 0,01). Indeks WMSI je kod muškaraca imao senzitivnost 96,0%, a specifičnost 82,4%. Kod žena je WMSI za predviđanje NKD imao senzitivnost 93,3% i specifičnost 90,6%. Zaključak. Naši rezultati su potvrdili uticaj pola na tačnost DSE testa u dijagnostici koronarne arterijske bolesti. Indeks WMSI, kao parametar DSE, identifikovan je kao značajan prognostički faktor za NKD kod oba pola, s tim što je senzitivnost bila viša kod muškaraca, a specifičnost kod žena.
References
GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392(10159): 1736–88. Erratum in: Lancet 2018; 392(10160): 2170. Erratum in: 2019; 393(10190): e44.
Timmis A, Vardas P, Townsend N, Torbica A, Katus H, De Smedt D, et al. European Society of Cardiology: cardiovascular dis-ease statistics 2021. Eur Heart J 2022; 43(8): 716–99.
Ni H, Coady S, Rosamond W, Folsom AR, Chambless L, Russell SD, et al. Trends from 1987 to 2004 in sudden death due to coronary heart disease: the Atherosclerosis Risk in Communi-ties (ARIC) study. Am Heart J 2009; 157(1): 46–52.
Gupta A, Wang Y, Spertus JA, Geda M, Lorenze N, Nkonde-Price C, et al. Trends in acute myocardial infarction in young pa-tients and differences by sex and race, 2001 to 2010. J Am Coll Cardiol 2014; 64(4): 337–45.
Shaw LJ, Miller DD, Romeis JC, Kargl D, Younis LT, Chaitman BR. Gender differences in the noninvasive evaluation and management of patients with suspected coronary artery dis-ease. Ann Intern Med 1994; 120(7): 559–66.
Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, Lloyd-Jones DM, et al. Effectiveness-based guidelines for the preven-tion of cardiovascular disease in women–2011 update: a guideline from the American Heart Association. Circulation 2011; 123(11): 1243–62. Erratum in: Circulation 2011; 123(22): e624. Erratum in: Circulation 2011; 124(16): e427.
Mosca L, Banka CL, Benjamin EJ, Berra K, Bushnell C, Dolor RJ, et al. Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update. Circulation 2007; 115(11): 1481–501. Erratum in: Circulation 2007; 115(15): e407.
Mosca L, Appel LJ, Benjamin EJ, Berra K, Chandra-Strobos N, Fabunmi RP, et al. Evidence-based guidelines for cardiovascu-lar disease prevention in women. Circulation 2004; 109(5): 672–93.
Heijenbrok-Kal MH, Fleischmann KE, Hunink MG. Stress echo-cardiography, stress single-photon-emission computed tomog-raphy and electron beam computed tomography for the as-sessment of coronary artery disease: a meta-analysis of diag-nostic performance. Am Heart J 2007; 154(3): 415–23.
Afidi I, Quiñones MA, Zoghbi WA, Cheirif J. Dobutamine stress echocardiography: sensitivity, specificity, and predictive value for future cardiac events. Am Heart J 1994; 127(6): 1510–5.
Mazeika PK, Nadazdin A, Oakley CM. Prognostic value of do-butamine echocardiography in patients with high pretest like-lihood of coronary artery disease. Am J Cardiol 1993; 71(1): 33–9.
Poldermans D, Fioretti PM, Boersma E, Cornel JH, Borst F, Ver-meulen EG, et al. Dobutamine-atropine stress echocardiog-raphy and clinical data for predicting late cardiac events in pa-tients with suspected coronary artery disease. Am J Med 1994; 97(2): 119–25.
Kamaran M, Teague SM, Finkelhor RS, Dawson N, Bahler RC. Prognostic value of dobutamine stress echocardiography in pa-tients referred because of suspected coronary artery disease. Am J Cardiol 1995; 76(12): 887–91.
Williams MJ, Odabashian J, Lauer MS, Thomas JD, Marwick TH. Prognostic value of dobutamine echocardiography in patients with left ventricular dysfunction. J Am Coll Cardiol 1996; 27(1): 132–9.
Marcovitz PA, Shayna V, Horn RA, Hepner A, Armstrong WF. Value of dobutamine stress echocardiography in determining the prognosis of patients with known or suspected coronary artery disease. Am J Cardiol 1996; 78(4): 404–8.
Elhendy A, Geleijnse ML, van Domburg RT, Nierop PR, Polder-mans D, Bax JJ, et al. Gender differences in the accuracy of dobutamine stress echocardiography for the diagnosis of coro-nary artery disease. Am J Cardiol 1997; 80(11): 1414–8.
Secknus MA, Marwick TH. Influence of gender on physiologic response and accuracy of dobutamine echocardiography. Am J Cardiol 1997; 80(6): 721–4.
Pepine CJ, Ferdinand KC, Shaw LJ, Light-McGroary KA, Shah RU, Gulati M, et al. Emergence of nonobstructive coronary artery disease: a woman's problem and need for change in def-inition on angiography. J Am Coll Cardiol 2015; 66(17): 1918–33.
Bach DS, Muller DW, Gros BJ, Amstrong WF. False positive dobutamine stress echocardiograms: characterization of clini-cal, echocardiographic and angiographic findings. J Am Coll Cardiol 1994; 24(4): 928–33.
Cortigiani L, Dodi C, Paolini EA, Bernardi D, Bruno G, Nannini E. Prognostic value of pharmacological stress echocardiog-raphy in women with chest pain and unknown coronary artery disease. J Am Coll Cardiol 1998; 32(7): 1975–81.
Dionisopoulos PN, Collins JD, Smart SC, Knickelbine TA, Sagar KB. The value of dobutamine stress echocardiography for the detection of coronary artery disease in women. J Am Soc Echocardiogr 1997; 10(8): 811–7.
Woodward W, Dockerill C, McCourt A, Upton R, O'Driscoll J, Balkhausen K, et al. Real-world performance and accuracy of stress echocardiography: the EVAREST observational multi-centre study. Eur Heart J Cardiovasc Imaging 2022; 23(5): 689–98.
Sedlak TL, Lee M, Izadnegahdar M, Merz CN, Gao M, Hum-phries KH. Sex differences in clinical outcomes in patients with stable angina and no obstructive coronary artery disease. Am Heart J 2013; 166(1): 38–44.
Savage ML, Hay K, Anderson B, Scalia G, Burstow D, Murdoch D, et al. The Prognostic Value of Echocardiographic Wall Mo-tion Score Index in ST-Segment Elevation Myocardial Infarc-tion. Crit Care Res Pract 2022; 2022: 8343785.
Antoni ML, Mollema SA, Delgado V, Atary JZ, Borleffs CJ, Bo-ersma E, et al. Prognostic importance of strain and strain rate after acute myocardial infarction. Eur Heart J 2010; 31(13): 1640–7.
Wierzbowska-Drabik K, Picano E, Simiera M, Plewka M, Kręcki R, Peruga JZ, et al. A head-to-head comparison of wall motion score index, force, strain, and ejection fraction for the predic-tion of SYNTAX and Gensini coronary scores by dobutamine stress echocardiography Kardiol Pol 2020; 78(7–8): 715–24.
Playford D, Stewart S, Harris SA, Chan YK, Strange G. Pattern and Prognostic Impact of Regional Wall Motion Abnormali-ties in 255 697 Men and 236 641 Women Investigated with Echocardiography. J Am Heart Assoc 2023; 12(22): e031243.
Chuah SC, Pellikka PA, Roger VL, McCully BR, Seward BJ. Role of dobutamine stress echocardiography in predicting out-come in 860 patients with known or suspected coronary artery disease. Circulation 1998; 97(15): 1474–80.