title: Head to Head Comparison of Stress Echocardiography with Exercise Electrocardiography for the Detection of Coronary Artery Stenosis in Women.
abstract: BACKGROUND
  Exercise-stress electrocardiography (ECG) is initially recommended for the diagnosis of coronary artery disease. But its value has been questioned in women because of suboptimal diagnostic accuracy. Stress echocardiography had been reported to have comparable test accuracy in women. But the data comparing the diagnostic accuracy of exercise-stress ECG and stress echocardiography directly are few. The aim of the study was to compare the diagnostic accuracy of exercise-stress ECG and dobutamine stress echocardiography (DSE) in Korean women.
  
  
  METHODS
  202 consecutive female patients who presented with chest pain in outpatient clinic, and who underwent treadmill exercise test (TET), DSE and coronary angiography were included for the study. The diagnostic accuracy TET and DSE were calculated by the definition of > 50% or > 75% coronary artery stenosis (CAS).
  
  
  RESULTS
  The sensitivity and specificity were higher with DSE (70.4, 94.6%) than TET (53.7, 73.6%) for detection of > 50% CAS. The higher accuracy of DSE was maintained after exclusion of the patients who could not achieve over 85% age predicted heart rate before ischemia induction. DSE also showed greater diagnostic accuracy than TET by > 75% CAS criteria, and in subsets of patient with intermediate pretest probability.
  
  
  CONCLUSIONS
  In the diagnosis of CAS, DSE showed higher accuracy than TET in female patients who presented with chest pain. As well as the test accuracy, adequate stress was more feasible with DSE than TET. These finding suggests DSE may be used as the first-line diagnostic tool in the detection of CAS in women with chest pain.
authors.affiliation: Department of Cardiology, Korea University Anam Hospital, Seoul, Korea.
authors.forename: Mi-Na
authors.initials: MN
authors.lastname: Kim
authors.affiliation: Department of Cardiology, Dankook University Cheil General Hospital & Women's Healthcare Center, Seoul, Korea.
authors.forename: Su-A
authors.initials: SA
authors.lastname: Kim
authors.affiliation: Department of Cardiology, Korea University Ansan Hospital, Ansan, Korea.
authors.forename: Yong-Hyun
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Cardiology, Korea University Anam Hospital, Seoul, Korea.
authors.forename: Soon Jun
authors.initials: SJ
authors.lastname: Hong
authors.affiliation: Department of Cardiology, Korea University Anam Hospital, Seoul, Korea.
authors.forename: Seong-Mi
authors.initials: SM
authors.lastname: Park
authors.affiliation: Department of Cardiology, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Mi Seung
authors.initials: MS
authors.lastname: Shin
authors.affiliation: Department of Cardiology, Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Myung-A
authors.initials: MA
authors.lastname: Kim
authors.affiliation: Department of Cardiology, Hallym University Medical Center, Chuncheon, Korea.
authors.forename: Kyoung-Soon
authors.initials: KS
authors.lastname: Hong
authors.affiliation: Department of Cardiology Ewha Womans University Medical Center, Seoul, Korea.
authors.forename: Gil Ja
authors.initials: GJ
authors.lastname: Shin
authors.affiliation: Department of Cardiology, Korea University Anam Hospital, Seoul, Korea.
authors.forename: Wan-Joo
authors.initials: WJ
authors.lastname: Shim
keywords: Coronary artery disease; Dobutamine stress echocardiography; Exercise-stress electrocardiography; Women