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Prognostic value of pharmacological stress echocardiography in diabetic patients
A D'Andrea1, S Severino, P Caso
1Medical-Surgical Physiopathology of Cardiopulmunar and Respiratory System and Associated Biotechnologies, Second University of Naples, Corsa Europa 72, Naples, Italy. adandrea@synapsis.it
Insights
Pharmacological stress echocardiography helps predict cardiovascular events in diabetic patients. A low peak ejection fraction (EF) and positive stress test indicate higher mortality risk.
Area of Science:
- Cardiology
- Diabetology
- Medical Imaging
Background:
- Diabetic patients have a higher risk of coronary artery disease (CAD).
- Prognostic tools are crucial for managing cardiovascular risk in this population.
Purpose of the Study:
- To evaluate the prognostic value of pharmacological stress echocardiography in diabetic patients.
- To identify predictors of cardiac death and major adverse cardiovascular events.
Main Methods:
- A cohort of 325 diabetic patients underwent pharmacological stress echocardiography.
- Follow-up averaged 34 months, recording cardiac deaths and non-fatal myocardial infarctions.
- Univariate and multivariate analyses were used to identify independent predictors.
Main Results:
- Univariate analysis showed a positive stress echocardiography for ischemia predicted increased cardiovascular death risk.
- Multivariate analysis identified advanced age and peak ejection fraction (EF) <40% as independent predictors of cardiac death.
- Peak EF <40%, rest wall motion score index, and prior myocardial infarction predicted hard events. In subgroups, peak EF <40% and a positive stress test strongly predicted cardiovascular mortality.
Conclusions:
- Pharmacological stress echocardiography is a valuable prognostic tool in diabetic patients.
- A reduced peak ejection fraction (EF) <40% and a positive stress test are powerful independent predictors of cardiovascular mortality in this cohort.
Abstract:
Our study was undertaken to assess the prognostic significance of pharmacological stress echocardiography in 325 diabetic patients. Pharmacological stress echocardiography was performed for diagnosis of coronary artery disease in 128 patients, and for risk stratification in 197 patients. Follow-up was 34 months. Cardiac-related death and non-fatal myocardial infarction were considered hard events. During the follow-up period, there were 38 deaths and 23 acute non-fatal myocardial infarctions. By univariate analysis, a pharmacological stress echocardiography positive response for ischaemia indicated an increased risk of cardiovascular death. However, by multivariate analysis, advanced age and peak ejection fraction <40% were the only independent predictors of cardiac death. The same peak ejection fraction (EF) <40%, rest wall motion score index and previous myocardial infarction were independent predictors of hard events. After dividing the population into two subgroups on the basis of EF at rest, only a peak EF <40% and a pharmacological stress echocardiography positive test were powerful independent predictors of cardiovascular mortality.