Prediction of cardiovascular events in clinically selected high-risk NIDDM patients. Prognostic value of exercise stress test and thallium-201 single-photon emission computed tomography.
OBJECTIVE
We evaluated the prognostic value of an exercise stress test and thallium-201 scintigraphy for the prediction of cardiac events in selected high-risk NIDDM patients.


METHODS
NIDDM patients (n = 158, 105 men, aged 63 +/- 9 years) with two or more of the following criteria were prospectively included: age > or = 65 years, active smoking, hypertension > 160/95 mmHg, hypercholesterolemia (cholesterol > 5.70 mmol/l or LDL > 3.10 mmol/l), peripheral artery disease, abnormal rest electrocardiogram, or microalbuminuria (20-200 micrograms/min). An exercise-stress scintigraphy was performed in 77 patients able to exercise, while a dipyridamole scintigraphy was performed in 80 patients unable to exercise. Follow-up was 23 +/- 17 months. Major end points were cardiac deaths or nonfatal myocardial infarction.


RESULTS
The annual event rate was 7.31% (deaths: 8, myocardial infarction: 14). Independent predictors of events were as follows: an age > 60 (P = 0.02), an abnormal rest electrocardiogram (P = 0.02), microalbuminuria (P = 0.001), the inability to exercise (P = 0.009), and the presence of more than two defects on scintigraphy (P = 0.001). A cardiac death occurred in 1.3% of patients able to exercise versus 8.8% of patients unable to exercise (odds ratio = 6.8, P = 0.001). Among patients unable to exercise, large perfusion defects corresponded to an annual mortality rate of 22.3%. Conversely, the negative predictive value of a normal scintigraphy for the occurrence of death was 97%.


CONCLUSIONS
Inability to exercise and large perfusion defects on thallium-201 scan are major predictors of future death and myocardial infarction in high-risk NIDDM patients.
Vanzetto
G
G
Department of Cardiology, University Hospital, Grenoble, France. gerald.vanzetto@ujf-grenoble.fr
Halimi
S
S
Hammoud
T
T
Fagret
D
D
Benhamou
P Y
PY
Cordonnier
D
D
Denis
B
B
Machecourt
J
J
D000203:Activities of Daily Living; D000368:Aged; D000704:Analysis of Variance; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000503:physiopathology; D004176:Dipyridamole; D015444:Exercise; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon; D014665:Vasodilator Agents
D008076:Cholesterol, HDL; D013794:Thallium Radioisotopes; D014665:Vasodilator Agents; D004176:Dipyridamole; D002784:Cholesterol