Clinical relevance of chest pain during dobutamine stress echocardiography in women

Abstract

Background: Dobutamine stress echocardiography (DSE) is commonly used for diagnosis and management of patients with known or suspected coronary artery disease. Chest pain occurring during DSE potentially provides additional diagnostic accuracy. Our experience suggests that chest pain occurs frequently in women undergoing DSE.

Hypothesis: It was the purpose of this study to determine the frequency with which chest pain occurs in women undergoing DSE and the relation to inducible ischemia or coronary artery stenosis.

Methods: To determine the prevalence and clinical significance or chest pain during DSE, we reviewed the records of 154 consecutive women undergoing DSE in our laboratory. Of these, 59 patients (37.5%) also underwent coronary angiography. The presence or absence of chest pain was correlated with ECG changes, left ventricular wall motion abnormalities during DSE, and coronary stenosis by angiography.

Results: Forty-one women (26%) developed chest pain during DSE. Patients experiencing chest pain were older (58.5 +/- 9.3 vs. 54.9 +/- 12.6; p = 0.05), and had lower resting heart rates (71 +/- 12.2 vs. 77.9 +/- 14.9; p = 0.008), but received similar maximum doses of dobutamine and reached comparable peak heart rates (131.1 +/- 17.4 vs. 133.5 +/- 21.7; p = NS). Patients with chest pain more commonly exhibited ST-segment depression > or = 1 mm during dobutamine infusion (13/41, 32%, vs. 17/113, 15%; p = 0.02), but chest pain showed no statistically significant correlation with abnormal DSE or with coronary stenosis.

Conclusions: In women undergoing DSE, chest pain occurs in 26% and does not appear to be related to inducible myocardial ischemia. Electrocardiographic changes occur more frequently in patients who experience chest pain, but are also often unrelated to inducible myocardial ischemia.