Exercise echocardiography is an accurate and cost-efficient technique for detection of coronary artery disease in women

Objectives. 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 (