CLINICAL RESEARCH: DIABETES AND OBESITY
Prognostic Value of Pharmacological Stress Echocardiography in Diabetic and Nondiabetic Patients With Known or Suspected Coronary Artery Disease
Lauro Cortigiani, MD*,*,
Riccardo Bigi, MD ,
Rosa Sicari, MD ,
Patrizia Landi, BSc,
Francesco Bovenzi, MD* and
Eugenio Picano, MD
* Division of Cardiology, Lucca Hospital, Lucca, Italy
Cardiology, Department of Medicine and Surgery, University School of Medicine, Milan, Italy
Institute of Clinical Physiology, CNR, Pisa, Italy
Manuscript received June 29, 2005;
revised manuscript received September 8, 2005,
accepted September 12, 2005.
* Reprint requests and correspondence: Dr. Lauro Cortigiani, Divisione di Cardiologia, Ospedale "Campo di Marte," 55032 Lucca, Italy (Email: lacortig{at}tin.it).
OBJECTIVES: We sought to compare the prognostic value of pharmacological stress echocardiography (SE) in diabetic and nondiabetic patients with known or suspected coronary artery disease.
BACKGROUND: Although SE is a useful tool for risk stratification of patients with diabetes, it has not been established whether it retains the same prognostic information in diabetic patients compared with nondiabetic patients.
METHODS: A total of 5,456 patients (749 diabetics) undergoing dipyridamole (n = 3,306) or dobutamine (n = 2,150) SE were prospectively followed up for the occurrence of hard events (death and/or nonfatal myocardial infarction).
RESULTS: During a median time of 31 months, 411 deaths and 236 infarctions occurred. There were 132 events in diabetic patients and 515 in nondiabetic patients (18% vs. 11%, respectively; p < 0.0001). Moreover, 1,607 (29%) patients underwent coronary revascularization and were censored. Ischemia at SE, resting wall motion score index, and age were independent predictors of death and hard events in both diabetic and nondiabetic patients. Compared with a normal test, ischemia and scar test patterns were associated to significantly lower age-corrected five-year hard event-free survival in diabetic as well as nondiabetic patients. However, a normal test was associated with a greater than two-fold annual event rate in diabetic patients as compared with nondiabetics who were either younger (2.6% vs. 1.0%) or older (5.5% vs. 2.2%) than 65 years of age.
CONCLUSIONS: Stress echocardiography is equally effective in risk stratifying diabetic and nondiabetic patients independently of age. However, the normal test result predicts a less favorable outcome in diabetic than in nondiabetic patients.
|
Abbreviations and Acronyms
| | CAD = coronary artery disease | | SE = stress echocardiography | | WMSI = wall motion score index |
|
This article has been cited by other articles:
|
|
|
|
 
A. Kapur, A. C. Qureshi, S. Gallagher, M. Finlay, I. S. Malik, J. Mayet, M. Roughton, K. J. Beatt, R. J. Hall, and P. Nihoyannopoulos
Myocardial function may improve equally in diabetic patients following both multivessel percutaneous coronary intervention and coronary artery bypass grafting: results from a CARDia trial substudy
Eur Heart J Cardiovasc Imaging,
December 1, 2011;
12(12):
904 - 909.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Cortigiani, R. Bigi, and R. Sicari
Is viability still viable after the STICH trial?
Eur Heart J Cardiovasc Imaging,
November 11, 2011;
(2011)
jer237v1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Cortigiani and E. Picano
Chapter 13 Stress echocardiography
The EAE Textbook of Echocardiography,
March 1, 2011;
1(1):
med-9780199599639-chapter - med-9780199599639-chapter.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
J. M. Van Werkhoven, F. Cademartiri, S. Seitun, E. Maffei, A. Palumbo, C. Martini, G. Tarantini, L. J. Kroft, A. de Roos, A. C. Weustink, et al.
Diabetes: Prognostic Value of CT Coronary Angiography--Comparison with a Nondiabetic Population
Radiology,
July 1, 2010;
256(1):
83 - 92.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. L. Jellis, C. Jenkins, R. Leano, J. H. Martin, and T. H. Marwick
Reduced End-Systolic Pressure-Volume Ratio Response to Exercise: A Marker of Subclinical Myocardial Disease in Type 2 Diabetes
Circ Cardiovasc Imaging,
July 1, 2010;
3(4):
443 - 449.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L Cortigiani, T Bombardini, A Corbisiero, A Mazzoni, F Bovenzi, and E Picano
The additive prognostic value of end-systolic pressure-volume relation in patients with diabetes mellitus having negative dobutamine stress echocardiography by wall motion criteria
Heart,
September 1, 2009;
95(17):
1429 - 1435.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Sicari, P. Nihoyannopoulos, A. Evangelista, J. Kasprzak, P. Lancellotti, D. Poldermans, J.-U. Voigt, J. L. Zamorano, and on behalf of the European Association of Echocardi
Stress echocardiography expert consensus statement: European Association of Echocardiography (EAE) (a registered branch of the ESC)
Eur Heart J Cardiovasc Imaging,
July 1, 2008;
9(4):
415 - 437.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Cortigiani, F. Rigo, S. Gherardi, R. Sicari, M. Galderisi, F. Bovenzi, and E. Picano
Additional Prognostic Value of Coronary Flow Reserve in Diabetic and Nondiabetic Patients With Negative Dipyridamole Stress Echocardiography by Wall Motion Criteria
J. Am. Coll. Cardiol.,
October 2, 2007;
50(14):
1354 - 1361.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Cortigiani, R. Sicari, A. Desideri, R. Bigi, F. Bovenzi, E. Picano, and on behalf of the VIDA (Viability Identification wi
Dobutamine stress echocardiography and the effect of revascularization on outcome in diabetic and non-diabetic patients with chronic ischaemic left ventricular dysfunction
Eur J Heart Fail,
October 1, 2007;
9(10):
1038 - 1043.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. A. Beller
Noninvasive Screening for Coronary Atherosclerosis and Silent Ischemia in Asymptomatic Type 2 Diabetic Patients: Is it Appropriate and Cost-Effective?
J. Am. Coll. Cardiol.,
May 15, 2007;
49(19):
1918 - 1923.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. D. Schuijf, W. Wijns, J. W. Jukema, D. E. Atsma, A. de Roos, H. J. Lamb, M. P.M. Stokkel, P. Dibbets-Schneider, I. Decramer, P. De Bondt, et al.
Relationship Between Noninvasive Coronary Angiography With Multi-Slice Computed Tomography and Myocardial Perfusion Imaging
J. Am. Coll. Cardiol.,
December 19, 2006;
48(12):
2508 - 2514.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
