Document Detail


Prognostic value of dobutamine-atropine stress myocardial perfusion imaging in patients with diabetes.
MedLine Citation:
PMID:  12196440     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Exercise tolerance in patients with diabetes is frequently impaired due to noncardiac disease such as claudication and polyneuropathy. This study assesses the prognostic value of dobutamine stress myocardial perfusion imaging in patients with diabetes. RESEARCH DESIGN AND METHODS: A total of 207 consecutive diabetic patients who were unable to undergo exercise stress testing underwent dobutamine-atropine stress myocardial perfusion imaging. Follow-up was successful in 206 of 207 (99.5%) patients. A total of 12 patients underwent early (<60 days) revascularization and were excluded from the analysis. End points during follow-up were hard cardiac events, defined as cardiac death and nonfatal myocardial infarction. RESULTS: Abnormal myocardial perfusion was detected in 125 (64%) patients. During 4.1 +/- 2.4 years of follow-up, 73 (38%) deaths occurred, 36 (49%) of which were due to cardiac causes. Nonfatal myocardial infarction occurred in 7 (4%) patients, and 45 (23%) patients underwent late coronary revascularization. Cardiac death occurred in 2 of 69 (3%) patients with normal myocardial perfusion and in 34 of 125 (27%) patients with perfusion abnormalities (P < 0.0001). A multivariable Cox proportional hazard model demonstrated that, in addition to clinical and stress test data, an abnormal scan had an incremental prognostic value for prediction of cardiac death (hazard ratio 7.2, 95% CI 1.7-30). The summed stress score was an important predictor of cardiac death; the hazard ratio was 1.2 (95% CI 1.07-1.34) per one-unit increment. CONCLUSIONS: Dobutamine-atropine stress myocardial perfusion imaging provides additional prognostic information incremental to clinical data in patients with diabetes who are unable to undergo exercise stress testing.
Authors:
Arend F L Schinkel; Abdou Elhendy; Ron T van Domburg; Jeroen J Bax; Eleni C Vourvouri; Fabiola B Sozzi; Roelf Valkema; Jos R T C Roelandt; Don Poldermans
Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Diabetes care     Volume:  25     ISSN:  0149-5992     ISO Abbreviation:  Diabetes Care     Publication Date:  2002 Sep 
Date Detail:
Created Date:  2002-08-28     Completed Date:  2003-02-07     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7805975     Medline TA:  Diabetes Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1637-43     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Aged
Atropine / diagnostic use
Coronary Circulation
Death, Sudden, Cardiac
Diabetes Mellitus, Type 1 / diagnosis*,  mortality
Dobutamine / diagnostic use
Exercise Test / methods*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Myocardial Infarction / diagnosis,  mortality
Parasympatholytics / diagnostic use
Predictive Value of Tests
Prognosis
Survival Analysis
Sympathomimetics / diagnostic use
Chemical
Reg. No./Substance:
0/Parasympatholytics; 0/Sympathomimetics; 34368-04-2/Dobutamine; 51-55-8/Atropine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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