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The stress echo prognostic gender gap
L Cortigiani1, G Gigli, A Vallebona
1Cardiovascular Research Foundation, Castelfranco Veneto (Treviso), Italy.
Insights
Female gender independently predicts cardiac events in patients experiencing myocardial ischemia during stress echocardiography. Women show lower 5-year infarction-free survival compared to men, highlighting a significant prognostic difference.
Area of Science:
- Cardiology
- Echocardiography
- Clinical Prognosis
Background:
- Pharmacological stress echocardiography is used to evaluate coronary artery disease.
- Prognostic differences in myocardial ischemia between sexes are not fully understood.
Purpose of the Study:
- To investigate if myocardial ischemia during stress echocardiography has a different prognosis in men versus women.
- To identify independent predictors of cardiac events in patients with stress-induced ischemia.
Main Methods:
- A study of 1733 patients (941 men, 792 women) undergoing dipyridamole or dobutamine stress echocardiography.
- Analysis of cardiac events, deaths, infarctions, and revascularizations over a median follow-up of 25 months for the ischemic group.
- Multivariate analysis to identify independent predictors of cardiac events, including gender, age, and echocardiographic parameters.
Main Results:
- Myocardial ischemia was detected in 460 patients; women were older and had more comorbidities.
- Female gender was an independent predictor of cardiac events in the entire ischemic population and in those with suspected coronary artery disease (CAD).
- Five-year infarction-free survival was significantly lower in women (71%) compared to men (82%) within the ischemic groups.
Conclusions:
- Female gender is an independent predictor of adverse cardiac events in patients with pharmacologically induced myocardial ischemia.
- Stress echocardiography reveals sex-specific prognostic differences in patients with coronary artery disease.
- These findings underscore the importance of considering gender in risk stratification for patients with ischemic heart disease.
Aims:
To investigate whether myocardial ischaemia elicitable during pharmacological stress echocardiography portends different prognosis in men and women.
Methods And Results:
The study group was made by 1733 patients (941 men, 792 women) who underwent dipyridamole (n=1008) or dobutamine (n=725) stress echo for evaluation of known or suspected coronary artery disease. An ischaemic response was found in 460 patients (308 men, 152 women). Considering the whole ischaemic population, women were older (P<0.0001) and more likely to have hypertension (P=0.02) and hypercholesterolaemia (P=0.04) than men. No difference in age and risk factors was evidenced between the two sexes in the subset of 203 patients with ischaemia and suspected coronary artery disease. During follow-up (25 +/- 24 months for the ischaemic and 37 +/- 25 months for the non-ischaemic sample), there were 113 cardiac events (45 deaths and 68 infarctions) and 232 revascularizations. Revascularization rate in ischaemic population was similar in both sexes (P=0.36). Multivariate predictors of cardiac events in the whole ischaemic group were resting WMSI (HR=2.7, 95% CI 1.3--3.3;P=0.0050), female gender (HR=2.2, 95% CI 1.2--3.7;P=0.0062), age > or = l65 years (HR=1.9, 95% CI=1.0--3.6;P=0.0427), and Delta WMSI (HR=2.1, 95% CI=1.0--3.7;P=0.0447). Female gender (HR=2.7, 95% CI 1.1--6.3;P=0.0233) was the only independent prognostic predictor in patients with ischaemia and suspected coronary artery disease. Five-year infarction-free survival was 82% in men and 71% in women in the whole ischaemic population (P=0.0041) as well as in the ischaemic group with suspected coronary artery disease (CAD) (P=0.0175). In the non-ischaemic sample resting WMSI (HR=4.8), history of myocardial infarction (HR=2.5), and hypercholesterolaemia (HR=1.8) were independent predictors of outcome at multivariate analysis, whilst the gender had no prognostic importance.
Conclusions:
Our results show that female gender is an independent predictor of cardiac events in patients with myocardial ischaemia induced by pharmacological stress echocardiography.
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