Diagnostic and prognostic value of vasodilator stress echocardiography in asymptomatic Type 2 diabetic patients with positive exercise thallium scintigraphy: a pilot study.
OBJECTIVE
To assess the diagnostic and prognostic value of vasodilator stress echocardiography in Type 2 diabetic patients with positive exercise perfusion scintigraphy.


METHODS
Of an initial cohort of 50 asymptomatic Type 2 diabetic patients undergoing exercise single photon emission computed tomography (SPECT) thallium scintigraphy, 24 had a positive thallium scan, with a reversible perfusion defect. All these 24 underwent high dose (up to 0.84 mg/kg in 10 min) dipyridamole echocardiography and coronary angiography independently of stress echocardiography results. All patients were then followed for 61+/-22 months.


RESULTS
Coronary angiography showed normal coronary arteries in 11 patients and significant (> 50% visually assessed diameter reduction in a major vessel) coronary artery disease in 13. Stress echocardiography showed 92% sensitivity and 100% specificity for non-invasive detection of coronary artery disease. During follow-up, five patients experienced cardiac events: heart failure in one, angina with subsequent revascularization in two, and myocardial infarction in two. Event-free survival was 100% in the 12 patients with negative and 58% in the 12 patients with positive stress echocardiography (P = 0.08 by Mantel-Cox test).


CONCLUSIONS
In asymptomatic Type 2 diabetic patients with stress-induced perfusion defects, vasodilator stress echocardiography is an excellent diagnostic and prognostic tool proven with long-term follow-up.
Gaddi
O
O
Cardiology Division, Reggio Emilia, Pisa, Italy.
Tortorella
G
G
Picano
E
E
Pantaleoni
M
M
Manicardi
E
E
Varga
A
A
Moneta
I
I
Guiducci
U
U
D017023:Coronary Angiography; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004176:Dipyridamole; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000209:etiology; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon; D014665:Vasodilator Agents
D013794:Thallium Radioisotopes; D014665:Vasodilator Agents; D004176:Dipyridamole