Stress Echo Predicts Risk in Diabetics and Nondiabetics

Researchers report that pharmacological stress echocardiography is equally effective in stratifying cardiac risk in diabetes and nondiabetics.

Dr. Lauro Cortigiani of Lucca Hospital and colleagues note that exercise testing is of limited value in diabetics because exercise capacity is often impaired. Pharmacological stress echocardiography has proved to be useful in these patients but it is not known whether the prognostic value is the same as that in nondiabetics.

To investigate, the researchers studied 5456 patients of whom 749 were diabetics. All underwent echocardiography with dipyridamole or dobutamine as a stressor. The findings are published in the February issue of the Journal of the American College of Cardiology.

Over a median follow-up of 31 months, there were 411 deaths and 236 infarctions. These events were significantly more prevalent in diabetics than nondiabetics (18% versus 11%).

Ischemia at echocardiography, resting wall motion score index and age were independent predictors of such events in both groups of patients. Ischemia and scar test patterns were also predictive of risk in both patient groups.

However, diabetics who had normal results had more than twice the annual risk of death or infarction than did nondiabetics. This was true for diabetics under the ages of 65 years (2.6% versus 1%) and also in older diabetics (5.5% versus 2.2%).

Dr. Cortigiani stated that, "Diabetic patients with normal tests have less favorable outcome as compared to their age-matched nondiabetic counterparts.

These results "indicate that achievement of as much metabolic control as possible, adequate treatment of risk factors, primary prevention with statins and antiplatelet agents, as well as close follow-up including periodic evaluation by stress testing should represent pivotal targets of management of diabetic patients with normal pharmacologic stress echocardiogram."

J Am Coll Cardiol 2006;47:605-610.