Document Detail


Prognostic stratification of diabetic patients by exercise echocardiography.
MedLine Citation:
PMID:  11345364     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The aim of this study was to assess the incremental value of exercise echocardiography for the risk stratification of diabetic patients. BACKGROUND: There are currently insufficient outcome data in diabetic patients to define the role of stress echocardiography as a prognostic tool. METHODS: We studied the prognostic value of exercise echocardiography in 563 patients with diabetes mellitus (mean age 64 +/- 11 years, 336 men) and known or suspected ischemic heart disease (IHD). RESULTS: Cardiac events occurred in 50 patients (cardiac death in 23 and nonfatal myocardial infarction [MI] in 27) during a median follow-up period of three years. Event rate was lower in patients with normal as compared to those with abnormal exercise echocardiography at one year (0% vs. 1.9%), three years (1.8% vs. 11.9%), and five years (7.6% vs. 23.3%), respectively (p = 0.0001). Patients with multivessel distribution of echocardiographic abnormalities had the highest event rate (2.9% at one year, 15.2% at three years, and 32.8% at five years). In an incremental multivariate analysis model, exercise echocardiography increased the chi-square of the clinical and exercise ECG model from 29 to 44.8 (p = 0.0001). CONCLUSIONS: Exercise echocardiography provides incremental data for risk stratification of diabetic patients with known or suspected IHD. Patients with a normal exercise echocardiogram have a low event rate. Patients with multivessel distribution of exercise echocardiographic abnormalities are at the highest risk of cardiac events, as one-third of these patients experience cardiac death or nonfatal MI during the five years following exercise echocardiography.
Authors:
A Elhendy; A M Arruda; D W Mahoney; P A Pellikka
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Validation Studies    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  37     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2001 May 
Date Detail:
Created Date:  2001-05-09     Completed Date:  2001-05-21     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1551-7     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Chi-Square Distribution
Diabetes Complications*
Diabetes Mellitus / blood,  diagnosis*
Disease-Free Survival
Echocardiography / methods*,  standards
Electrocardiography / standards
Exercise Test / methods*,  standards
Female
Follow-Up Studies
Hemodynamics
Humans
Male
Middle Aged
Multivariate Analysis
Myocardial Ischemia / etiology*,  mortality*
Predictive Value of Tests
Prognosis
Questionnaires
Risk Assessment
Risk Factors
Severity of Illness Index
Ventricular Function, Left

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