title: Diagnostic and prognostic value of vasodilator stress echocardiography in asymptomatic Type 2 diabetic patients with positive exercise thallium scintigraphy: a pilot study.
abstract: 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.
authors.affiliation: Cardiology Division, Reggio Emilia, Pisa, Italy.
authors.forename: O
authors.initials: O
authors.lastname: Gaddi
authors.forename: G
authors.initials: G
authors.lastname: Tortorella
authors.forename: E
authors.initials: E
authors.lastname: Picano
authors.forename: M
authors.initials: M
authors.lastname: Pantaleoni
authors.forename: E
authors.initials: E
authors.lastname: Manicardi
authors.forename: A
authors.initials: A
authors.lastname: Varga
authors.forename: I
authors.initials: I
authors.lastname: Moneta
authors.forename: U
authors.initials: U
authors.lastname: Guiducci
mesh_terms: 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
chemical_list: D013794:Thallium Radioisotopes; D014665:Vasodilator Agents; D004176:Dipyridamole