Stress echocardiography for risk stratification of diabetic patients with known or suspected coronary artery disease

Riccardo Bigi, Alessandro Desideri, Lauro Cortigiani, Jeroen J. Bax, Leopoldo Celegon, Cesare Fiorentini

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE-Coronary artery disease (CAD) is a leading cause of mortality and morbidity in diabetic patients; therefore, their risk stratification is a relevant issue. Because exercise tolerance is frequently impaired in these patients, pharmacological stress echocardiography (SE) has been suggested as a valuable alternative. Our aim was to evaluate the prognostic value of this technique in diabetic patients with known or suspected CAD. RESEARCH DESIGN AND METHODS-A total of 259 consecutive diabetic patients underwent pharmacological SE (dobutamine in 108 patients and dipyridamole in 151 patients) and follow-up for 24 ± 22 months. A comparison between the prognostic value of SE and exercise electrocardiography (ECG) was made in a subgroup of 120 subjects. RESULTS-A total of 13 cardiac deaths and 13 nonfatal infarctions occurred during follow-up, and 58 patients were revascularized. Univariate predictors of outcome were known CAD, positive SE, rest and peak wall motion score index (WMSI), and peak/rest WMSI variation. Peak WMSI was the only significant and independent prognostic indicator (odds ratio 11; 95% CI 4-29, P <0.0001) on multivariate Cox's analysis. After adjustment for the most predictive clinical and exercise ECG variables, SE provided 43% additional prognostic information (gain in X2 = 7, P <0.01). Moreover, positive SE was associated with a significantly lower event-free survival. CONCLUSIONS-SE effectively predicts cardiac events in diabetic patients with known or suspected CAD and adds additional prognostic information as compared with exercise ECG.

Original languageEnglish
Pages (from-to)1596-1601
Number of pages6
JournalDiabetes Care
Volume24
Issue number9
Publication statusPublished - 2001

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine

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