Coronary artery disease screening in type II diabetic patients: prognostic value of rest and stress echocardiography.
AIM
Presence of inducible ischemia in type II diabetic patients is associated with an adverse outcome, but less is known about prognostic value of resting wall motion abnormalities (WMA).


MATERIALS AND METHODS
From October 2006 to May 2008, 278 patients underwent to CAD screening, according to ADA criteria, by dobutamine stress echocardiography (DSE). Between July and September 2009, all patients were contacted to verify the occurrence of new cardiac events.


RESULTS
Resting-WMA were present in 63 patients; 88 subjects showed inducible ischemia. During the follow-up, we observed 24 new cardiac events; patients with a good outcome showed less frequently resting WMA (19 vs 50%). Inducible ischemia (71% vs 28%; p<0.001) and a more extensive area of inducible ischemia, expressed by a higher value of peak WMSI (1.63±0.45 vs 1.17±0.31; p<0.0001), were more frequent in patients with adverse outcome. A Cox regression analysis showed that only a higher peak WMSI (HR 6.645, 95% CI 2.782-15.874, p<0.0001) was associated with a bad outcome. Event-free survival was lower in presence of rest WMA (79% vs 94%, p<0.0001) and a higher peak WMSI (66% vs 95%, p<0.0001).


CONCLUSIONS
In diabetic patients presence of an extensive inducible ischemia was independently associated with a worst outcome; resting WMA were associated with reduced event-free survival.
['Innocenti|Francesca|F|', 'Bartalucci|Francesca|F|', 'Boni|Vanessa|V|', 'Vicidomini|Sonia|S|', 'Mannucci|Edoardo|E|', 'Monami|Matteo|M|', 'Pini|Riccardo|R|']
D003324:Coronary Artery Disease D003924:Diabetes Mellitus, Type 2 D018572:Disease-Free Survival D025401:Echocardiography, Stress D005919:Glomerular Filtration Rate D006801:Humans D017202:Myocardial Ischemia D011379:Prognosis D012044:Regression Analysis D012189:Retrospective Studies
Inducible ischemia Rest wall motion abnormalities Dobutamine stress echocardiography