Stress echocardiography in the evaluation of women presenting with chest pain syndrome: a randomized, prospective comparison with electrocardiographic stress testing.

摘要

OBJECTIVE: To evaluate the relative value of three stress testing modalities for establishing the presence of coronary artery disease in women presenting with chest pain. BACKGROUND: Echocardiographic testing modalities have the potential to be more effective than standard electrocardiographic stress testing (EST), but they require prospective evaluation. METHODS: Patients with no cardiac history and at least two cardiac risk factors were randomly assigned to one of three initial diagnostic strategies: treadmill EST (n=54), treadmill echocardiographic stress testing (ExE) (n=57) or dobutamine stress echocardiography (DSE) (n=47). Patients were followed prospectively for 28.1+/-14.2 months. The nature of the presenting chest pain was established clinically. RESULTS: Twelve patients (7.6%) were determined to have had cardiac chest pain, 128 patients (81.0%) received a diagnosis of noncardiac chest pain and 18 patients (11.4%) had indeterminate results. The echocardiographic testing modalities were associated with fewer indeterminate results than was EST (two of 104 [1.9%] versus 13 of 54 [24.1%]). All modalities were highly effective in excluding cardiac chest pain, with negative predictive values of 91.3%, 83.7% and 88.4%, respectively, for EST, DSE and ExE. The proportion of cases for which both definitive and accurate results were provided was 92.9% for DSE, 82.4% for ExE and 67.3% for EST. CONCLUSIONS: The results support the favourable prognosis of women presenting with chest pain syndrome and the reliability of negative results obtained with any of the testing modalities. Echocardiographic testing modalities are more likely than EST to provide both definitive and accurate results and would, therefore, seem to be the superior primary noninvasive testing modality in this patient population.