Stress echocardiography for risk stratification of diabetic patients with known or suspected coronary artery disease.
OBJECTIVE
Coronary artery disease (CAD) is a leading cause of mortality and morbidity in diabetic patients; therefore, their risk stratification is a relevant issue. Because exercise tolerance is frequently impaired in these patients, pharmacological stress echocardiography (SE) has been suggested as a valuable alternative. Our aim was to evaluate the prognostic value of this technique in diabetic patients with known or suspected CAD.


METHODS
A total of 259 consecutive diabetic patients underwent pharmacological SE (dobutamine in 108 patients and dipyridamole in 151 patients) and follow-up for 24 +/- 22 months. A comparison between the prognostic value of SE and exercise electrocardiography (ECG) was made in a subgroup of 120 subjects.


RESULTS
A total of 13 cardiac deaths and 13 nonfatal infarctions occurred during follow-up, and 58 patients were revascularized. Univariate predictors of outcome were known CAD, positive SE, rest and peak wall motion score index (WMSI), and peak/rest WMSI variation. Peak WMSI was the only significant and independent prognostic indicator (odds ratio 11; 95% CI 4-29, P < 0.0001) on multivariate Cox's analysis. After adjustment for the most predictive clinical and exercise ECG variables, SE provided 43% additional prognostic information (gain in X(2) = 7, P < 0.01). Moreover, positive SE was associated with a significantly lower event-free survival.


CONCLUSIONS
SE effectively predicts cardiac events in diabetic patients with known or suspected CAD and adds additional prognostic information as compared with exercise ECG.
Bigi
R
R
Cardiovascular Research Foundation, S. Giacomo Hospital, Castelfranco Veneto, Italy. rbigi@tiscalinet.it
Desideri
A
A
Cortigiani
L
L
Bax
J J
JJ
Celegon
L
L
Fiorentini
C
C
D000318:Adrenergic beta-Agonists; D000367:Age Factors; D000368:Aged; D003327:Coronary Disease / Q000175:diagnosis* / Q000503:physiopathology*; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000503:physiopathology; D004176:Dipyridamole; D018572:Disease-Free Survival; D004280:Dobutamine; D004452:Echocardiography / Q000187:drug effects; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012737:Sex Factors; D012907:Smoking; D013997:Time Factors; D014665:Vasodilator Agents
D000318:Adrenergic beta-Agonists; D014665:Vasodilator Agents; D004280:Dobutamine; D004176:Dipyridamole