Prognostic stratification of diabetic patients by exercise echocardiography

J Am Coll Cardiol. 2001 May;37(6):1551-7. doi: 10.1016/s0735-1097(01)01199-8.


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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Aged
  • Chi-Square Distribution
  • Diabetes Complications*
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / diagnosis*
  • Disease-Free Survival
  • Echocardiography / methods*
  • Echocardiography / standards
  • Electrocardiography / standards
  • Exercise Test / methods*
  • Exercise Test / standards
  • Female
  • Follow-Up Studies
  • Hemodynamics
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Ischemia / etiology*
  • Myocardial Ischemia / mortality*
  • Predictive Value of Tests
  • Prognosis
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Surveys and Questionnaires
  • Ventricular Function, Left