Key result
In diabetic patients unable to exercise, abnormal myocardial perfusion on dobutamine stress imaging strongly predicted cardiac death compared to normal perfusion (27% vs 3%; HR 7.2, 95% CI 1.7-30).
Why the study?
Does an abnormal dobutamine-atropine stress myocardial perfusion imaging scan predict hard cardiac events in diabetic patients unable to undergo exercise stress testing?
Cohort (n=207)
Does an abnormal dobutamine-atropine stress myocardial perfusion imaging scan predict hard cardiac events in diabetic patients unable to undergo exercise stress testing?
Dobutamine-atropine stress myocardial perfusion imaging provides significant incremental prognostic value for predicting cardiac death in diabetic patients who are unable to exercise.
Answers are grounded in this paper and cite their sources.
May aid risk stratification in exercise-intolerant diabetics; extends observational prognostic data but leaves open effects on management.
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.
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Schinkel et al. (2002) conducted a cohort in Diabetes (n=207). Abnormal myocardial perfusion on dobutamine-atropine stress imaging vs. Normal myocardial perfusion was evaluated on Cardiac death (HR 7.2, 95% CI 1.7-30, p=<0.0001). In diabetic patients unable to exercise, abnormal myocardial perfusion on dobutamine stress imaging strongly predicted cardiac death compared to normal perfusion (27% vs 3%; HR 7.2, 95% CI 1.7-30).
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