Document Detail

Prevalence and prognosis of left ventricular systolic dysfunction in asymptomatic diabetic patients without known coronary artery disease referred for stress single-photon emission computed tomography and assessment of left ventricular function.
MedLine Citation:
PMID:  17719308     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The prevalence and prognosis of reduced left ventricular ejection fraction (LVEF) in asymptomatic diabetic patients without known coronary artery disease (CAD) are not known. METHODS: We examined 1046 asymptomatic diabetic patients (age 60 +/- 13 years, 69% male) without known CAD referred to a tertiary referral center for stress single-photon emission computed tomography (SPECT) and assessment of LVEF. Patients were stratified according to the presence of normal LVEF (> or = 50%), mildly reduced LVEF (35%-49%), or moderately/severely reduced LVEF (< 35%). Single-photon emission computed tomographic images were classified as low, intermediate, or high risk based on the summed stress score (normal = 56). The mean follow-up was 5.3 +/- 3.3 years. RESULTS: The prevalence of reduced LVEF was 16.7% (n = 175, mean LVEF 40.0% +/- 7.7%). This group was older (63 +/- 11 vs 59 +/- 14 years, P = .005), had more peripheral arterial disease (45% vs 29%, P < .001), and had a higher prevalence of electrocardiographic Q waves (21% vs 9%, P < .001) than the group without reduced LVEF. Mean summed stress (44.8 +/- 9.8 vs 51.7 +/- 6.3, P < .001), summed reversibility (4.7 +/- 5.0 vs 2.9 +/- 4.5, P < .001), and summed rest scores (49.4 +/- 7.2 vs 54.6 +/- 3.1, P < .001) were significantly more abnormal in the reduced LVEF group. High-risk summed stress score was significantly more common in the reduced LVEF group (46% vs 16%, P < .001). Survival was significantly lower in patients with any reduction in LVEF compared with those without reduced LVEF (10-year survival, 29% vs 57%, P < .0001). By multivariate analysis, reduced LVEF was independently associated with increased mortality (adjusted chi2 = 6.26, P = .01). CONCLUSIONS: In this population of asymptomatic diabetic patients without known CAD referred for stress SPECT, 1 in 6 patients had reduced LVEF. Most of these patients have intermediate-/high-risk SPECT scans. The annual mortality rates of the groups with and without reduced LVEF were 7% and 4%, respectively.
Panithaya Chareonthaitawee; Paul Sorajja; Navin Rajagopalan; Todd D Miller; David O Hodge; Robert L Frye; Raymond J Gibbons
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American heart journal     Volume:  154     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2007 Sep 
Date Detail:
Created Date:  2007-08-27     Completed Date:  2007-09-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  567-74     Citation Subset:  AIM; IM    
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
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MeSH Terms
Diabetes Complications / epidemiology*,  physiopathology
Exercise Test
Middle Aged
Positron-Emission Tomography* / methods
Ventricular Dysfunction, Left / diagnosis*,  epidemiology*,  physiopathology
Ventricular Function, Left

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