Incremental prognostic value of dobutamine-atropine stress 99mTc-tetrofosmin myocardial perfusion imaging for predicting outcome in diabetic patients with limited exercise capacity.
OBJECTIVE
This study assessed the incremental value of dobutamine stress ( 99m)Tc-tetrofosmin single-photon emission computed tomography (SPECT) for the prediction of cardiac events in diabetic patients with limited exercise capacity.


METHODS
The study population comprised 125 consecutive diabetic patients (mean age 61+/-9 years, 61% men) who were unable to perform an exercise test and underwent dobutamine ( 99m)Tc-tetrofosmin SPECT. Follow-up was successful in 124 (99%) patients. Three patients who underwent early revascularisation (within 60 days) were excluded. End-points during follow-up were cardiac death and non-fatal myocardial infarction.


RESULTS
An abnormal scan (with the presence of reversible or fixed perfusion defects) was observed in 76 (63%) patients. During the follow-up (3.4+/-1.5 years), 36 patients died (19 cardiac deaths) and four patients had non-fatal myocardial infarction. Cardiac death occurred in one of 49 (2%) patients with a normal myocardial perfusion study and in 18 of 75 (24%) patients with an abnormal study (p<0.001). Abnormal scan was incremental to the clinical parameters in predicting cardiac death (chi(2)=48 vs 39, p<0.05) and hard cardiac events (chi(2)=50 vs 43, p<0.05).


CONCLUSIONS
Dobutamine stress ( 99m)Tc-tetrofosmin SPECT provides prognostic information additional to clinical data for the prediction of cardiac death and hard cardiac events in diabetic patients unable to perform an exercise test.
Pedone
Chiara
C
Department of Cardiology, Bellaria Hospital, Bologna, Italy.
Schinkel
Arend F L
AF
Elhendy
Abdou
A
van Domburg
Ron T
RT
Valkema
Roelf
R
Biagini
Elena
E
Simoons
Maarten L
ML
Bax
Jeroen J
JJ
Poldermans
Don
D
D017677:Age Distribution; D001285:Atropine; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000401:mortality*; D004280:Dobutamine; D005080:Exercise Test / Q000706:statistics & numerical data; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000401:mortality*; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000401:mortality*
D019275:Radiopharmaceuticals; D004280:Dobutamine; D001285:Atropine