Prognostic value of dobutamine stress echocardiography in patients with diabetes.
OBJECTIVE
The aim of this study was to assess the incremental value of dobutamine stress echocardiography (DSE) for the risk stratification of diabetic patients who are unable to perform an adequate exercise stress test. Exercise capacity is frequently impaired in patients with diabetes. The role of pharmacologic stress echocardiography in the risk stratification of diabetic patients has not been well defined.


METHODS
We studied 396 diabetic patients (mean age 61 +/- 11 years, 252 men [64%]) with limited exercise capacity who underwent DSE for evaluation of known or suspected coronary artery disease (CAD). End points were hard cardiac events (cardiac death and nonfatal myocardial infarction) and all causes of mortality.


RESULTS
During a median follow-up of 3 years, 97 patients (24%) died (55 cardiac deaths), and 27 patients had nonfatal myocardial infarction. In an incremental multivariate analysis model, clinical predictors of hard cardiac events were history of congestive heart failure, previous myocardial infarction, hypercholesterolemia, and ejection fraction at rest. The percentage of ischemic segments was incremental to the clinical model in the prediction of hard cardiac events (chi(2) = 37 vs. 18, P < 0.05). Clinical predictors of all causes of mortality were history of congestive heart failure, age, hypercholesterolemia, and ejection fraction at rest. Wall motion score index at peak stress was incremental to the clinical model in the prediction of mortality (chi(2) = 52 vs. 43, P < 0.05).


CONCLUSIONS
DSE provides incremental data for the prediction of mortality and hard cardiac events in patients with diabetes who are unable to perform an adequate exercise stress test.
Sozzi
Fabiola B
FB
Erasmus Medical Centre, Rotterdam, The Netherlands.
Elhendy
Abdou
A
Roelandt
Jos R T C
JR
van Domburg
Ron T
RT
Schinkel
Arend F L
AF
Vourvouri
Eleni C
EC
Bax
Jeroen J
JJ
De Sutter
Johan
J
Borghetti
Alberico
A
Poldermans
Don
D
D000318:Adrenergic beta-Agonists; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology*; D018572:Disease-Free Survival; D004280:Dobutamine; D004452:Echocardiography / Q000379:methods; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D000318:Adrenergic beta-Agonists; D004280:Dobutamine