Prognostic value of dobutamine-atropine stress myocardial perfusion imaging in patients with diabetes.
OBJECTIVE
Exercise tolerance in patients with diabetes is frequently impaired due to noncardiac disease such as claudication and polyneuropathy. This study assesses the prognostic value of dobutamine stress myocardial perfusion imaging in patients with diabetes.


METHODS
A total of 207 consecutive diabetic patients who were unable to undergo exercise stress testing underwent dobutamine-atropine stress myocardial perfusion imaging. Follow-up was successful in 206 of 207 (99.5%) patients. A total of 12 patients underwent early (<60 days) revascularization and were excluded from the analysis. End points during follow-up were hard cardiac events, defined as cardiac death and nonfatal myocardial infarction.


RESULTS
Abnormal myocardial perfusion was detected in 125 (64%) patients. During 4.1 +/- 2.4 years of follow-up, 73 (38%) deaths occurred, 36 (49%) of which were due to cardiac causes. Nonfatal myocardial infarction occurred in 7 (4%) patients, and 45 (23%) patients underwent late coronary revascularization. Cardiac death occurred in 2 of 69 (3%) patients with normal myocardial perfusion and in 34 of 125 (27%) patients with perfusion abnormalities (P < 0.0001). A multivariable Cox proportional hazard model demonstrated that, in addition to clinical and stress test data, an abnormal scan had an incremental prognostic value for prediction of cardiac death (hazard ratio 7.2, 95% CI 1.7-30). The summed stress score was an important predictor of cardiac death; the hazard ratio was 1.2 (95% CI 1.07-1.34) per one-unit increment.


CONCLUSIONS
Dobutamine-atropine stress myocardial perfusion imaging provides additional prognostic information incremental to clinical data in patients with diabetes who are unable to undergo exercise stress testing.
Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
Arend F L
AF
Schinkel
Abdou
A
Elhendy
Ron T
RT
van Domburg
Jeroen J
JJ
Bax
Eleni C
EC
Vourvouri
Fabiola B
FB
Sozzi
Roelf
R
Valkema
Jos R T C
JR
Roelandt
Don
D
Poldermans
D000368:Aged; D001285:Atropine; D003326:Coronary Circulation; D016757:Death, Sudden, Cardiac; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis* / Q000401:mortality; D004280:Dobutamine; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality; D010276:Parasympatholytics; D011237:Predictive Value of Tests; D011379:Prognosis; D016019:Survival Analysis; D013566:Sympathomimetics
D010276:Parasympatholytics; D013566:Sympathomimetics; D004280:Dobutamine; D001285:Atropine