Noninvasive evaluation of women with chest pain and no previous history of coronary artery disease (CAD) is a challenge. Angina is about twice as likely to be the presenting symptom of CAD in women as it is in men but is associated with a high prevalence of normal coronary arteries in women. Exercise stress testing used alone as an assessment is unreliable because of the high incidence of false-positive tests in women. Very little information is available on the prognostic value of pharmacologic stress echocardiography in women with chest pain and no previous CAD. Cortigiani and associates studied the use of pharmacologic stress echocardiography in the evaluation of women who present with chest pain and have no previous history of CAD.

A total of 456 women who presented with a history of chest pain and no evidence of acute myocardial ischemia or injury were studied. None of the patients had a previous history of CAD, valvular disease, or dilated or hypertrophic cardiomyopathies. The patients underwent stress testing with either dipyridamole or dobutamine using standard protocols. The echocardiogram was interpreted by two experts, with a third expert's opinion included if there was significant disagreement about the interpretation. The patients were followed for about three years. Follow-up data included cardiac and noncardiac deaths, nonfatal myocardial infarctions, unstable angina and coronary revascularization.

No major complications occurred during the study. Fifty-one patients had an echocardiogram that was positive for ischemia, while 68 had a positive electrocardiogram with a negative echocardiogram. The remainder of the study subjects had negative results on both tests. A total of 23 cardiac events, three cardiac deaths, 10 acute myocardial infarctions and 10 unstable angina events occurred. No cardiac events occurred in the patients who had a positive electrocardiogram with a negative echocardiogram.

The authors conclude that the use of pharmacologic stress echocardiography in women with chest pain and no previous history of CAD can differentiate between low or high risk in women who are at risk for cardiac events. In a patient with a negative test, the chance of having a cardiac event over a three-year period is less than 1 percent. Women with an abnormal electrocardiogram but a normal echocardiogram can be classified as low risk.