title: Seven-year follow-up after dobutamine stress echocardiography: impact of gender on prognosis.
abstract: OBJECTIVE
  The aim of this study was to investigate the effects of gender on long-term prognosis of patients undergoing dobutamine stress echocardiography (DSE).
  
  
  BACKGROUND
  Gender differences in the predictors of outcome among patients with known or suspected coronary artery disease undergoing DSE have not been adequately studied.
  
  
  METHODS
  We studied 2,276 men and 1,105 women with known or suspected coronary artery disease who underwent DSE. Follow-up events were cardiac death and nonfatal myocardial infarction (MI).
  
  
  RESULTS
  Dobutamine stress echocardiography was normal in 687 men (30%) and 483 women (44%) (p <0.0001). Ischemia on DSE was present in 1,194 men (52%) and 416 women (38%) (p <0.001). During a mean follow-up of 7 +/- 3.4 years, there were 894 (26%) deaths (442 attributed to cardiac causes) and 145 (4%) nonfatal MIs. The annual cardiac event rate was 2.5% in men and 1.2% in women with normal DSE. Independent predictors of cardiac events in patients with normal DSE using a Cox proportional hazards regression analysis were male gender (hazard ratio [HR]: 1.7 [range 1.1 to 2.8]), age (HR: 1.02 [range 1.01 to 1.04]), history of heart failure (HR: 3.4 [range 1.5 to 7.9]), previous MI (HR: 1.7 [range 1.1 to 2.8]), and diabetes (HR: 2.4 [range 1.3 to 4.5]). Independent predictors of cardiac events in patients with an abnormal DSE were age (HR: 1.03 [range 1.02 to 1.04]), history of heart failure (HR: 1.7 [range 1.3 to 2.1]), diabetes (HR: 1.4 [range 1.1 to 1.8]), heart rate at rest (HR: 2.8 [range 1.4 to 5.8]), wall motion abnormalities at rest (HR: 1.06 [range 1.04 to 1.09]), and ischemia on DSE (HR: 1.04 [range 1.02 to 1.07]). Myocardial ischemia was an independent predictor of cardiac events in both men and women.
  
  
  CONCLUSIONS
  Dobutamine stress echocardiography provides independent prognostic information in both men and women. In patients with normal DSE, gender is independently associated with cardiac events. The outcome of patients with abnormal DSE is not related to gender, after adjusting for stress echocardiographic abnormalities.
authors.affiliation: Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands.
authors.forename: Elena
authors.initials: E
authors.lastname: Biagini
authors.forename: Abdou
authors.initials: A
authors.lastname: Elhendy
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Vittoria
authors.initials: V
authors.lastname: Rizzello
authors.forename: Arend F L
authors.initials: AF
authors.lastname: Schinkel
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Miklos D
authors.initials: MD
authors.lastname: Kertai
authors.forename: Boudewijn J
authors.initials: BJ
authors.lastname: Krenning
authors.forename: Manolis
authors.initials: M
authors.lastname: Bountioukos
authors.forename: Claudio
authors.initials: C
authors.lastname: Rapezzi
authors.forename: Angelo
authors.initials: A
authors.lastname: Branzi
authors.forename: Maarten L
authors.initials: ML
authors.lastname: Simoons
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000401:mortality; D018572:Disease-Free Survival; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D012737:Sex Factors; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology