Assessment of dipyridamole stress echocardiography for risk stratification of diabetic patients

Abstract

BackgroundDespite advances in medical therapy, cardiovascular disease, mainly coronary artery disease (CAD), remains the leading cause of mortality among patients with diabetes mellitus (DM). The objective of the present study was to assess the effectiveness of dipyridamole stress echocardiography in identify diabetic patients at high risk for cardiovascular events.MethodsDipyridamole stress echocardiography was administered to 483 diabetic patients (294 women; mean age 63.41 ± 11.28 years) between July 2006 and December 2012.ResultsFollow-up data were available for 264 patients (163 women; mean age 64.3 ± 10.5 years): 250 with a negative stress echocardiography and 14 with a positive stress echo. During a mean follow-up time of 18 ± 14 months, a cardiovascular event occurred in 18 (6.8 %) patients, 12 (4.8 %) in patients with a negative stress echo (n = 250) during a mean follow-up period of 20 ± 16 months and 6 (42 %) in patients with positive stress echo (n = 14) during a mean follow-up of 13 ± 13 months. The positive and negative predictive values of stress echocardiography were 42 % and 96 % respectively. The accuracy value was 92 %. A Cox regression model showed that CAD (hazard ratio [HR] 5.4, 95 % confidence interval [CI] 1.9-15.4; p = 0.002) and positive stress echocardiography (HR 7.1, 95 % CI 2.5-20.5; p < 0.001) were significant predictors of cardiovascular events.ConclusionsFor patients with diabetes, a negative dipyridamole stress echocardiogram predicts favorable outcome during the first year of follow-up. A new stress imaging test should be done after 12 months in diabetic patients.

Stress Perfusion Cardiac Magnetic Resonance Imaging Effectively Risk Stratifies Diabetic Patients With Suspected Myocardial Ischemia

“…26 These results are particularly concerning due to the high proportion of diabetics who have exercise intolerance due to numerous factors, such a peripheral neuropathy, advanced age, skin ulceration, and peripheral arterial disease. 4 On the basis of these results, some groups have advocated for serial risk stratification every 2–3 years in diabetics, 9, 12, 27 which is not highly feasible due to rising costs and prevalence of diabetes, as well as the risk of cumulative ionizing radiation from SPECT imaging. 28 …”

“…2, 3 Unfortunately, noninvasive risk assessment of diabetic patients remains challenging owing to multiple factors, including more advanced disease at time of presentation, limited exercise capacity due to peripheral arterial disease and microvascular complications, and increased prevalence of silent MI and multi-vessel coronary disease resulting in balanced ischemia. 4, 5 Numerous studies have reported that diabetic populations with normal single-photon emission computed tomography (SPECT) or stress echocardiographic assessment may remain at high-risk of adverse cardiac events, 6–9 particularly those who are unable to exercise and require pharmacological stress testing. 10–12 …”

The distribution of cardiac diagnostic testing for acute coronary syndrome in the Brazilian healthcare system: A national geospatial evaluation of health access

“…Diagnostic evaluation is typically a combination of electrocardiogram (ECG), laboratory testing (troponin, CK-MB), cardiac catheterization, and functional testing, which is commonly referred to as the stress test [2]. Studies have demonstrated that in patients with cardiovascular risk factors, a stress test can accurately identify those at risk of cardiac events in the near future [3–5]. Despite the widespread use of stress tests, there has been a resurgent debate over the proper role of stress testing in the evaluation of patients with possible ACS: some have argued that stress testing provides valuable prognostic information and risk-stratification in appropriate patients while others have argued that stress testing can produce both false positive and false negative results and does not reduce mortality [6, 7].…”

Type-2 diabetic aldehyde dehydrogenase 2 mutant mice (ALDH 2*2) exhibiting heart failure with preserved ejection fraction phenotype can be determined by exercise stress echocardiography

“…In the clinic, exercise stress echocardiography is performed in order to evaluate whether the myocardium is receiving adequate blood flow and oxygen under increased myocardial demand [ 25 , 26 ]. This is also a methodology used to determine cardiac function in HFpEF [ 27 ] besides used for myocardial ischemic diseases [ 28 ].…”