Vol 4, No 3 (2003): Practical Diabetology
Other materials agreed with the Editors
Published online: 2003-05-22
Prognostic value of dobutamine stress echocardiography in patients with diabetes
Diabetologia Praktyczna 2003;4(3):237-244.
Abstract
INTRODUCTION. The aim of this study was to assess the incremental value
of dobutamine stress echocardiography (DSE) for the risk stratification of diabetic
patients who are unable to perform an adequate exercise stress test. Exercise
capacity is frequently impaired in patients with diabetes. The role of pharmacologic
stress echocardiography in the risk stratification of diabetic patients has not
been well defined.
MATERIAL AND METHODS. We studied 396 diabetic patients (mean age 61 ± 11 years, 252 men [64%]) with limited exercise capacity who underwent DSE for evaluation of known or suspected coronary artery disease (CAD). End points were hard cardiac events (cardiac death and nonfatal myocardial infarction) and all causes of mortality.
RESULTS. During a median follow-up of 3 years, 97 patients (24%) died (55 cardiac deaths), and 27 patients had nonfatal myocardial infarction. In an incremental multivariate analysis model, clinical predictors of hard cardiac events were history of congestive heart failure, previous myocardial infarction, hypercholesterolemia, and ejection fraction at rest. The percentage of ischemic segments was incremental to the clinical model in the prediction of hard cardiac events (c2 = 37 vs. 18, P < 0.05). Clinical predictors of all causes of mortality were history of congestive heart failure, age, hypercholesterolemia, and ejection fraction at rest. Wall motion score index at peak stress was incremental to the clinical model in the prediction of mortality (c2 = 52 vs. 43, P < 0.05).
CONCLUSIONS. DSE provides incremental data for the prediction of mortality and hard cardiac events in patients with diabetes who are unable to perform an adequate exercise stress test.
MATERIAL AND METHODS. We studied 396 diabetic patients (mean age 61 ± 11 years, 252 men [64%]) with limited exercise capacity who underwent DSE for evaluation of known or suspected coronary artery disease (CAD). End points were hard cardiac events (cardiac death and nonfatal myocardial infarction) and all causes of mortality.
RESULTS. During a median follow-up of 3 years, 97 patients (24%) died (55 cardiac deaths), and 27 patients had nonfatal myocardial infarction. In an incremental multivariate analysis model, clinical predictors of hard cardiac events were history of congestive heart failure, previous myocardial infarction, hypercholesterolemia, and ejection fraction at rest. The percentage of ischemic segments was incremental to the clinical model in the prediction of hard cardiac events (c2 = 37 vs. 18, P < 0.05). Clinical predictors of all causes of mortality were history of congestive heart failure, age, hypercholesterolemia, and ejection fraction at rest. Wall motion score index at peak stress was incremental to the clinical model in the prediction of mortality (c2 = 52 vs. 43, P < 0.05).
CONCLUSIONS. DSE provides incremental data for the prediction of mortality and hard cardiac events in patients with diabetes who are unable to perform an adequate exercise stress test.
Keywords: dobutamine stress echocardiographycoronary artery diseasediabetes mellitus