title: Incremental prognostic value of dobutamine-atropine stress 99mTc-tetrofosmin myocardial perfusion imaging for predicting outcome in diabetic patients with limited exercise capacity.
abstract: 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.
authors.affiliation: Department of Cardiology, Bellaria Hospital, Bologna, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Pedone
authors.forename: Arend F L
authors.initials: AF
authors.lastname: Schinkel
authors.forename: Abdou
authors.initials: A
authors.lastname: Elhendy
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Roelf
authors.initials: R
authors.lastname: Valkema
authors.forename: Elena
authors.initials: E
authors.lastname: Biagini
authors.forename: Maarten L
authors.initials: ML
authors.lastname: Simoons
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: 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*
chemical_list: D019275:Radiopharmaceuticals; D004280:Dobutamine; D001285:Atropine