Abstract 12050: Gender Differences in the Predictive Value of Stress Echocardiography, With and Without Perfusion Imaging, in Predicting Outcome

Abstract

Background: Stress perfusion imaging with real time myocardial contrast echocardiography (RTMCE) may improve the detection of coronary artery disease (CAD) when compared to conventional stress echocardiography (CSE), where contrast is used only for approved indication of enhancing left ventricular opacification. Previous studies, however, have suggested there may be gender differences in the predictive value of CSE, and it is unknown whether these differences exist with RTMCE. The purpose of this study was to prospectively compare differences in clinical outcome between men and women who were referred for stress RTMCE versus CSE.

Methods: A total of 1069 females and 994 males with intermediate pre-test probability referred for dobutamine or exercise stress were prospectively randomized to either RTMCE or CSE. Definity contrast was used for CSE only when endocardial border delineation was inadequate (63% of studies). Death and non-fatal myocardial infarction (MI) were considered end points, with any subsequent revascularization as a time dependent co-variate.

Results: Follow-up was available in 2014 patients (median 2.6 years). Mean age was 59 ± 13 years for women; 60±.12 years for men. There were no gender differences in the prevalence of diabetes, hypertension, or hyperlipidemia. Women more frequently had a positive family history for premature CAD, while men more frequently had prior revascularization or MI. In women, the only significant univariate (p=0.005) and multivariate (p=0.03) predictor of death/non-fatal MI was the presence of diabetes, especially in women who were randomized to CSE. In men, the only significant univariate and multivariate predictors of death or non-fatal MI were extent of inducible ischemia in those randomized to CSE, and a resting wall motion abnormality in those randomized to RTMCE.

Conclusions: There are significant gender differences in the predictive power of stress echocardiography performed with either RTMCE or CSE. Perfusion or wall motion findings are not independent predictors of outcome in women, while resting and stress imaging variables are predictive in men.