Evaluation using dobutamine stress echocardiography in patients with insulin-dependent diabetes mellitus before kidney and/or pancreas transplantation.
The purpose of this study was to examine the ability of dobutamine stress echocardiography to stratify patients with juvenile onset, insulin-dependent diabetes mellitus who are being considered for kidney and/or pancreas transplantation, into high-or low-risk groups for future cardiac events. Fifty-three such patients underwent dobutamine stress echocardiography before kidney and/or pancreas transplantation. Cardiac events, including cardiac death, nonfatal myocardial infarction, unstable angina, pulmonary edema, and need for coronary revascularization, occurring between the time of the dobutamine stress echocardiogram and the last patient follow-up contact were retrospectively identified. Twenty patients 938%) had an abnormal dobutamine stress echocardiogram. Eleven patients had 15 cardiac events over a mean (+/- SD) follow-up period of 418 +/- 269 days. Event rates were 45% among those with an abnormal, versus 6% among those with a normal dobutamine stress echocardiogram (p = 0.002). The result of the dobutamine stress test independently predicted prognosis in a multivariate analysis (p = 0.003, odds ratio = 12.7). We conclude that dobutamine stress echocardiography accurately stratifies patients with juvenile onset, insulin-dependent diabetes being considered for kidney and/or pancreas transplantation for risk of future cardiac events.
Department of Medicine, Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis 46202-4800, USA.
J R
JR
Bates
S G
SG
Sawada
D S
DS
Segar
A J
AJ
Spaedy
O
O
Petrovic
N S
NS
Fineberg
H
H
Feigenbaum
T
T
Ryan
D000328:Adult; D015986:Confounding Factors, Epidemiologic; D017023:Coronary Angiography; D003922:Diabetes Mellitus, Type 1 / Q000000981:diagnostic imaging*; D004280:Dobutamine; D004452:Echocardiography / Q000379:methods; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016035:Pancreas Transplantation; D011237:Predictive Value of Tests; D012306:Risk
D004280:Dobutamine