Safety and feasibility of dobutamine-atropine stress echocardiography for the diagnosis of coronary artery disease in diabetic patients unable to perform an exercise stress test.

Elhendy, Abdou; Domburg, Ron T. van; Poldermans, Don; Bax, J. J.; Nierop, Peter R; Geleijnse, Marcel L.; Roelandt, Jos R.T.C.

doi:10.2337/diacare.21.11.1797

Cited by 69 publications

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“…Although exercise ECG is the most common stress modality used for the noninvasive evaluation of CAD, exercise tolerance in diabetic patients may be impaired, particularly because of the higher prevalence of peripheral vascular disease. In the study by Elhendy et al (14), 13% of 1,446 consecutive patients with limited exercise capacity referred for evaluation of myocardial ischemia had an established diagnosis of diabetes. This emphasizes the central role of imaging techniques coupled with pharmacological stress for the diagnostic and prognostic assessment of CAD in these patients.…”

Section: Incremental Prognostic Value Of Sementioning

confidence: 99%

“…Therefore, assessing risk for cardiac events in these patients is a relevant clinical issue. Scintigraphic imaging techniques have greater prognostic value than exercise electrocardiography (ECG) in diabetic patients (13), whereas prognostic studies with stress echocardiography (SE) are still lacking, despite the proven safety, feasibility, and diagnostic effectiveness of this technique (14,15).…”

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Stress Echocardiography for Risk Stratification of Diabetic Patients With Known or Suspected Coronary Artery Disease

et al. 2001

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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 Ϯ 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 followup, 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 Ͻ 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 X 2 ϭ 7, P Ͻ 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. Diabetes Care 24:1596 -1601, 2001C ardiovascular disease is the leading cause of death in patients with diabetes (1-3); in particular, coronary artery disease (CAD) is the cause of death in more than half of these patients (4). Diabetes is present in as many as 30% of patients hospitalized because of acute coronary syndromes (5) and is associated with greater mortality during the acute phase of myocardial infarction and a higher morbidity in the postinfarction period (6,7). The risk of adverse outcome is independent of the conventional risk factors for CAD (8): patients with diabetes but without other risk factors for atherosclerosis have a chance of death from CAD two to four times that of age-matched controls (4). Although revascularization procedures are associated with greater long-term mortality (9 -11), coronary artery bypass grafting can improve survival in diabetic patients with multivessel CAD (12). Therefore, assessing risk for cardiac events in these patients is a relevant clinical issue. Scintigraphic imaging techniques have greater prognostic value than exercise electrocardiography (ECG) in diabetic patients (13), whereas prognostic studies with stress echocardiography (SE) are still lacking, despite the proven safety, feasibility, and diagnostic effectiveness of this technique (14,15).The purpose of this study was twofold: 1) to assess the long-term prognostic value of SE in diabetic patients with known or suspected CAD and 2) to compar...

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Section: Incremental Prognostic Value Of Sementioning

confidence: 99%

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Stress Echocardiography for Risk Stratification of Diabetic Patients With Known or Suspected Coronary Artery Disease

et al. 2001

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“…However, exercise capacity is frequently impaired in diabetic patients, particularly because of the higher prevalence of peripheral neuropathy and vascular disease in this population (11)(12)(13)(14). Dobutamine stress echocardiography (DSE) has been reported as a safe and feasible method for evaluation of CAD in diabetic patients with limited exercise capacity (15,16). However, data regarding the incremental value of the technique in the risk stratification of diabetic patients are scarce (2).…”

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Prognostic Value of Dobutamine Stress Echocardiography in Patients With Diabetes

et al. 2003

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OBJECTIVE -The aim of this study was to assess the incremental value of dobutamine stress echocardiography (DSE) for the risk stratification of diabetic patients who are unable to perform an adequate exercise stress test. Exercise capacity is frequently impaired in patients with diabetes. The role of pharmacologic stress echocardiography in the risk stratification of diabetic patients has not been well defined.RESEARCH DESIGN AND METHODS -We studied 396 diabetic patients (mean age 61 Ϯ 11 years, 252 men [64%]) with limited exercise capacity who underwent DSE for evaluation of known or suspected coronary artery disease (CAD). End points were hard cardiac events (cardiac death and nonfatal myocardial infarction) and all causes of mortality.RESULTS -During a median follow-up of 3 years, 97 patients (24%) died (55 cardiac deaths), and 27 patients had nonfatal myocardial infarction. In an incremental multivariate analysis model, clinical predictors of hard cardiac events were history of congestive heart failure, previous myocardial infarction, hypercholesterolemia, and ejection fraction at rest. The percentage of ischemic segments was incremental to the clinical model in the prediction of hard cardiac events ( 2 ϭ 37 vs. 18, P Ͻ 0.05). Clinical predictors of all causes of mortality were history of congestive heart failure, age, hypercholesterolemia, and ejection fraction at rest. Wall motion score index at peak stress was incremental to the clinical model in the prediction of mortality ( 2 ϭ 52 vs. 43, P Ͻ 0.05).CONCLUSIONS -DSE provides incremental data for the prediction of mortality and hard cardiac events in patients with diabetes who are unable to perform an adequate exercise stress test. Diabetes Care 26:1074 -1078, 2003D iabetes is a major risk factor for coronary artery disease (CAD) and its complications (1-7). Identification of diabetic patients at a high risk of death and myocardial infarction is an essential step for planning the appropriate management strategy. Exercise stress testing is the most widely used method for evaluation of CAD (8 -10). However, exercise capacity is frequently impaired in diabetic patients, particularly because of the higher prevalence of peripheral neuropathy and vascular disease in this population (11)(12)(13)(14). Dobutamine stress echocardiography (DSE) has been reported as a safe and feasible method for evaluation of CAD in diabetic patients with limited exercise capacity (15,16). However, data regarding the incremental value of the technique in the risk stratification of diabetic patients are scarce (2). Additionally, currently there is no outcome data to support the role of stress echocardiography in the prediction of all causes of mortality in diabetic patients.The aim of this study was to assess the incremental value of DSE in the prediction of death and hard cardiac events in diabetic patients after adjustment for clinical data. RESEARCH DESIGN AND METHODS PatientsThe study included 408 patients with diabetes who were unable to perform an adequate exercise test, who un...

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“…Although the study was limited by the small size of the cohort it demonstrated similar diagnostic accuracy for dobutamine stress echocardiography in a diabetic population as in the general population. In another study on 55 diabetics who underwent dobutamine stress echocardiography and www.intechopen.com angiography the sensitivity and specificity of stress echocardiography were 81% and 85% (Elhendy et al, 1998). The efficacy of dobutamine stress echocardiography was compared to exercise ECG testing and SPECT nuclear perfusion imaging in 56 asymptomatic diabetic patients with three additional cardiovascular risk factors but normal resting ECG.…”

Section: Stress Echocardiographymentioning

confidence: 99%

Detection of Silent Ischemia in Patients with Type 2 Diabetes

Emilia¹,

Vlad²

2011

Recent Advances in the Pathogenesis, Prevention and Management of Type 2 Diabetes and Its Complications

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Safety and feasibility of dobutamine-atropine stress echocardiography for the diagnosis of coronary artery disease in diabetic patients unable to perform an exercise stress test.

Abstract: Dobutamine stress echocardiography is a feasible method for the diagnosis of coronary artery disease in patients with limited exercise capacity with a comparable safety, feasibility, and accuracy in diabetic and nondiabetic patients.

Cited by 69 publications

References 0 publications

Stress Echocardiography for Risk Stratification of Diabetic Patients With Known or Suspected Coronary Artery Disease

Stress Echocardiography for Risk Stratification of Diabetic Patients With Known or Suspected Coronary Artery Disease

Prognostic Value of Dobutamine Stress Echocardiography in Patients With Diabetes

Detection of Silent Ischemia in Patients with Type 2 Diabetes

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