title: Coronary artery disease screening in type II diabetic patients: prognostic value of rest and stress echocardiography.
abstract: OBJECTIVE
  Presence of inducible ischemia in type II diabetic patients is associated with an adverse outcome, but less is known about prognostic value of resting wall motion abnormalities (WMA).
  
  
  METHODS
  From October 2006 to May 2008, 278 patients underwent to CAD screening, according to ADA criteria, by dobutamine stress echocardiography (DSE). Between July and September 2009, all patients were contacted to verify the occurrence of new cardiac events.
  
  
  RESULTS
  Resting-WMA were present in 63 patients; 88 subjects showed inducible ischemia. During the follow-up, we observed 24 new cardiac events; patients with a good outcome showed less frequently resting WMA (19 vs 50%). Inducible ischemia (71% vs 28%; p<0.001) and a more extensive area of inducible ischemia, expressed by a higher value of peak WMSI (1.63±0.45 vs 1.17±0.31; p<0.0001), were more frequent in patients with adverse outcome. A Cox regression analysis showed that only a higher peak WMSI (HR 6.645, 95% CI 2.782-15.874, p<0.0001) was associated with a bad outcome. Event-free survival was lower in presence of rest WMA (79% vs 94%, p<0.0001) and a higher peak WMSI (66% vs 95%, p<0.0001).
  
  
  CONCLUSIONS
  In diabetic patients presence of an extensive inducible ischemia was independently associated with a worst outcome; resting WMA were associated with reduced event-free survival.
authors.affiliation: Intensive Observation Unit, Department of Critical Care Medicine and Surgery, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. Electronic address: innocentif@aou-careggi.toscana.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Innocenti
authors.affiliation: Geriatric Cardiology Unit, Department of Critical Care Medicine and Surgery, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Bartalucci
authors.affiliation: Intensive Observation Unit, Department of Critical Care Medicine and Surgery, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Boni
authors.affiliation: Intensive Observation Unit, Department of Critical Care Medicine and Surgery, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Sonia
authors.initials: S
authors.lastname: Vicidomini
authors.affiliation: Geriatric Cardiology Unit, Department of Critical Care Medicine and Surgery, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Mannucci
authors.affiliation: Geriatric Cardiology Unit, Department of Critical Care Medicine and Surgery, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Monami
authors.affiliation: Intensive Observation Unit, Department of Critical Care Medicine and Surgery, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Pini
mesh_terms: D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D018572:Disease-Free Survival; D025401:Echocardiography, Stress / Q000379:methods*; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D017202:Myocardial Ischemia / Q000473:pathology; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies
keywords: Dobutamine stress echocardiography; Inducible ischemia; Rest wall motion abnormalities