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

Leslee J. Shaw, Charles Vasey, Stephen Sawada, Curt Rimmerman, Thomas H. Marwick

Research output: Contribution to journalArticle

90 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)447-456
Number of pages10
JournalEuropean Heart Journal
Volume26
Issue number5
DOIs
StatePublished - Mar 1 2005

Fingerprint

Stress Echocardiography
Exercise
Mortality
Ischemia
Survival
Left Ventricular Function
Dobutamine
Proportional Hazards Models
Myocardial Ischemia
Coronary Disease
Registries
Research

Keywords

  • Echocardiography
  • Exercise testing
  • Gender
  • Prognosis
  • Ventricular function

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of gender on risk stratification by exercise and dobutamine stress echocardiography : Long-term mortality in 4234 women and 6898 men. / Shaw, Leslee J.; Vasey, Charles; Sawada, Stephen; Rimmerman, Curt; Marwick, Thomas H.

In: European Heart Journal, Vol. 26, No. 5, 01.03.2005, p. 447-456.

Research output: Contribution to journalArticle

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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.",
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