title: Exercise echocardiography is an accurate and cost-efficient technique for detection of coronary artery disease in women.
abstract: OBJECTIVE
  This study compared the accuracy and cost implications of using exercise echocardiography and exercise electrocardiography for detection of coronary artery disease in women.
  
  
  BACKGROUND
  The specificity of exercise electrocardiography in women is lower than in men. Exercise echocardiography accurately identifies coronary artery disease in women, but its utility in place of exercise electrocardiography is unclear.
  
  
  METHODS
  One hundred sixty-one women without a previous Q wave infarction underwent exercise echocardiography and coronary angiography. Positive findings were a new or worsening wall motion abnormality on the exercise echocardiogram and ST segment depression > 0.1 mV at 0.08 s after the J point on the exercise electrocardiogram (ECG).
  
  
  RESULTS
  Coronary artery stenosis > 50% diameter narrowing was present in 59 patients; the sensitivity (mean +/- SD) of exercise echocardiography was 80 +/- 3%. In 48 patients with an interpretable ECG, the sensitivity of exercise echocardiography was 81 +/- 4%, and that of the exercise ECG was 77 +/- 3% (p = 0.50). In 102 patients without coronary artery disease, the overall specificity of exercise echocardiography was 81 +/- 4%. In 70 patients with an interpretable ECG, the specificity of exercise echocardiography (80 +/- 3%) exceeded that of the exercise ECG (56 +/- 4%, p < 0.0004). The accuracy of exercise echocardiography was also greater than exercise electrocardiography (81 +/- 5% vs. 64 +/- 6%, p < 0.005). Exercise echocardiography stratified significantly more patients of intermediate (20% to 80%) pretest disease probability into the high (> 80%) or low (< 20%) posttest probability group. In women without a previous exercise ECG, the specificity of exercise echocardiography continued to exceed that of exercise electrocardiography (80 +/- 3% vs. 64 +/- 3%, p = 0.05). Exercise echocardiography had the best balance between accuracy and cost for the diagnosis of coronary artery disease in women.
  
  
  CONCLUSIONS
  Exercise echocardiography is more specific than exercise electrocardiography for diagnosis of coronary artery disease in women and is a cost-effective approach to the diagnosis of coronary artery disease because of the avoidance of inappropriate angiography.
authors.affiliation: Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195, USA.
authors.forename: T H
authors.initials: TH
authors.lastname: Marwick
authors.forename: T
authors.initials: T
authors.lastname: Anderson
authors.forename: M J
authors.initials: MJ
authors.lastname: Williams
authors.forename: B
authors.initials: B
authors.lastname: Haluska
authors.forename: J A
authors.initials: JA
authors.lastname: Melin
authors.forename: F
authors.initials: F
authors.lastname: Pashkow
authors.forename: J D
authors.initials: JD
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D003362:Cost-Benefit Analysis; D004452:Echocardiography / Q000191:economics; D004562:Electrocardiography; D005080:Exercise Test / Q000191:economics*; D005260:Female; D006801:Humans; D008875:Middle Aged; D012680:Sensitivity and Specificity