Prediction of Mortality by Stress Echocardiography in 2835 Diabetic and 11 305 Nondiabetic Patients

Abstract

Background— To compare the capability by stress echocardiography results to predict overall mortality in a large unselected cohort of diabetic and nondiabetic patients. Methods and Results— The study group comprised 14 140 patients (2835 diabetics and 11 305 nondiabetics) who underwent stress echocardiography for evaluation of known (n=5671) or suspected (n=8469) coronary artery disease. Ischemia at stress echocardiography was observed in 768 (27%) diabetics and 2644 (23%) nondiabetics. During a median follow-up of 30 months (first quartile, 9; third quartile, 63), 1213 patients died. In diabetics, multivariable indicators of mortality were age (hazard ratio [HR], 1.07, 95% confidence interval [CI], 1.06–1.09), rest wall motion abnormality (HR, 2.43; 95% CI, 1.83–3.22), and ischemia at stress echocardiography (HR, 1.71; 95% CI, 1.34–2.18). In nondiabetics, multivariable indicators of mortality were age (HR, 1.07; 95% CI, 1.06–1.08), rest wall motion abnormality (HR, 2.19; 95% CI, 1.86–2.57), male sex (HR, 1.65; 95% CI, 1.41–1.93), ischemia at stress echocardiography (HR, 1.54; 95% CI, 1.32–1.80), and antischemic therapy at the time of test (HR, 1.15; 95% CI, 1.00–1.32). In stress echo negative subjects for ischemia, antischemic therapy showed increased annual mortality in nondiabetic patients with (3.8% versus 3.1%; P =0.04) or without rest wall motion abnormality (1.6% versus 0.9%; P <0.0001); it failed to do so in diabetic patients with (5.7% versus 5.8%; P =0.89) or without rest wall motion abnormality (2.6% versus 1.9%; P =0.10). Conclusions— Ischemia at stress echocardiography is a strong and independent predictor of total mortality in diabetic as well as nondiabetic patients. Antischemic therapy markedly affects the negative predictive value of stress echocardiography in nondiabetic patients, whereas it is prognostically neutral in the diabetic population.

Effect of Coronary Revascularization on the Prognostic Value of Stress Myocardial Contrast Wall Motion and Perfusion Imaging

“…Electrocardiographic and hemodynamic changes during stress were not analyzed in our study, but these parameters have never been clearly associated with prognosis during dipyridamole stress echocardiography 7, 8, 9…”

Simple six-item clinical score improves risk prediction capability of stress echocardiography

“…It is also widely documented that the ability of SE to identify a low-risk subset is blunted in clinically identifiable subgroups, such as the elderly,19 males,20 diabetics,12 those with left bundle branch block,21 patients with baseline resting left ventricular dysfunction14 or patients undergoing antianginal therapy at the time of testing 22. Other studies have reported that the magnitude of risk associated with SE abnormalities is independent on sex,23 and it is more effective if not only the presence but also the extent of WMAs is considered24 25 also in elderly patients 26.…”

The prognostic role of stress echocardiography in a contemporary population and the clinical significance of limited apical ischaemia

“…In our population, 76% of recorded deaths were non-cardiac, whereas in the study by Sicari and coworkers (10), the non-cardiac deaths accounted for 52.1%. Recently, Cortigiani and coworkers (18) reported that inducible ischaemia in SE is correlated to all-cause mortality in a very large cohort of diabetic and non-diabetic patients. They were not able to separate cardiac deaths and hence reported all-cause mortality.…”