The yentl syndrome in women with arterial hypertension and positive findings on the echocardiography dipyridamole stress test

UNLABELLED: The aim of this study was to assess the possible gender differences between positive (new wall motion abnormality) combined dipyridamole stress echocardiography and coronary angiography or myocardial revascularization procedures. We evaluated 127 consecutive patients (82 males, 53.5 years old and 45 females, 56.1 years old) with systemic hypertension and chest pain (angina or atypical chest pain) who underwent pharmacological stress echocardiography (dipyridamole-atropine or dipyridamole-dobutamine) for detection of myocardial ischaemia. Coronary angiography was carried out in 84 patients (58 males and 26 females). Diagnostic accuracy of the test was the same in women as in men (92.3 vs 89.1%, females vs males, respectively). Coronary angiography was done in 73.6% of male and 66.7% of female patients with positive test; the difference was not significant. Over a two-year follow-up there were 31 myocardial revascularization procedures (20 coronary surgery and 11 angioplasty), 25 in men and 6 in women (p = 0.028). There was a trend in women with positive test to have less surgery or angioplasty (28.6%) than in men (45.3%), but the difference was not significant. Cox multivariate regression analysis revealed that women were less likely to receive revascularization (relative risk for females RR = 0.1457, 95% CI 0.0416-0.5101). CONCLUSION: Although diagnostic accuracy of third generation dipyridamole stress echocardiography was not different between men and women, in patients with positive test there was a trend in women to undergo coronary angiography and coronary surgery or angioplasty in lesser degree than in men. Cox multivariate model showed low relative risk of females for revascularization procedures and possible Yentl's syndrome in studied population.