Prognostic value of dipyridamole stress echocardiography in women

Stress echocardiography is an important diagnostic and prognostic tool in ischemic heart disease.

To evaluate the role of dipyridamole stress echocardiography (DSE) in the investigation of myocardial ischemia in women and its ability to predict combined events (cardiovascular death, acute myocardial infarction [AMI], unstable angina, coronary artery bypass grafting [surgery or percutaneous intervention] at an average follow-up of 16 months.

A prospective study using the protocol of dipyridamole at 0.84 mg in 10 minutes, associated with atropine (0.25 mg/min up to 1.0 mg).

This study evaluated 147 women. DSE was positive in 14 patients (9.5%), negative in 128 (87.1%) and inconclusive in 5 (3.4%). Events occurred in 8 patients, 7 had positive DSE. The other 138 did not present any events. Our of these, 128 had negative DSE. The sensitivity, specificity, accuracy, the positive and negative predictive values of the test before the events were respectively: 83%, 95%, 94%, 42% and 99%. The event-free survival for patients with negative DSE was 99.2% compared with 58% for positive DSE (p < 0.001). Univariate analysis identified the DSE result, basal electrocardiogram (ECG), LV ejection fraction, dyslipidemia, wall motion score index at rest and peak, history of AMI, coronary artery bypass grafting, as prognostic predictors related to outcomes. The results of DSE and ECG remained significantly associated with outcomes in the multivariate analysis (p < 0.001).

The baseline ECG and positive DSE were independent variables for the occurrence of outcomes. The DSE showed excellent negative predictive value, confirming its usefulness in evaluating prognosis in such patients.