Dual-Imaging Stress Echocardiography for Prognostic Assessment of High-Risk Asymptomatic Patients with Diabetes Mellitus

Lauro Cortigiani; Sonia Gherardi; Michela Faggioni; Francesco Bovenzi; Eugenio Picano; Christina Petersen; Sabrina Molinaro; Rosa Sicari

doi:10.1016/j.echo.2016.10.003

Dual-Imaging Stress Echocardiography for Prognostic Assessment of High-Risk Asymptomatic Patients with Diabetes Mellitus

J Am Soc Echocardiogr. 2017 Feb;30(2):149-158. doi: 10.1016/j.echo.2016.10.003. Epub 2016 Nov 11.

Authors

Lauro Cortigiani¹, Sonia Gherardi², Michela Faggioni¹, Francesco Bovenzi¹, Eugenio Picano³, Christina Petersen⁴, Sabrina Molinaro³, Rosa Sicari⁵

Affiliations

¹ Division of Cardiology, San Luca Hospital, Lucca, Italy.
² Division of Cardiology, Bufalini Hospital, Cesena, Italy.
³ Institute of Clinical Physiology, CNR, Pisa, Italy.
⁴ Fondazione Toscana G.Monasterio, Fondazione CNR-Regione Toscana, Pisa, Italy.
⁵ Institute of Clinical Physiology, CNR, Pisa, Italy. Electronic address: rosas@ifc.cnr.it.

PMID: 27843105
DOI: 10.1016/j.echo.2016.10.003

Abstract

Background: In patients with diabetes, the utility of diagnostic screening cardiac tests in subjects without clinical coronary artery disease remains controversial. The aim of this study was to assess the prognostic meaning of dual-imaging stress echocardiography (conventional wall motion analysis and Doppler-derived coronary flow velocity reserve [CFVR] of the left anterior descending coronary artery) in high-risk asymptomatic individuals with diabetes.

Methods: This was a prospective analysis of 230 asymptomatic patients with diabetes (128 men; mean age, 66 ± 9 years) with no clinical evidence of coronary artery disease, no Q waves or deep negative waves on the electrocardiogram, and no wall motion abnormalities on resting echocardiography. Of these subjects, 147 (64%) had target organ damage and 83 (36%) had two or more associated cardiovascular risk factors. All patients underwent dipyridamole stress echocardiography with CFVR assessment of the left anterior descending coronary artery by transthoracic Doppler, and test results were entered into a database at the time of testing for a clinical and outcome follow-up (mean, 4.6 ± 2.7 years).

Results: Inducible ischemia and reduced CFVR (≤2) were detected in six and 52 patients, respectively. A total of 54 subjects (23%) had abnormal test results (ischemia or reduced CFVR). During follow-up, 39 major adverse cardiac events (MACEs) occurred: 22 hard events (18 deaths and four nonfatal myocardial infarctions) and 17 coronary revascularizations. The yearly incidence rates of hard events and MACEs in the entire study population were 2.1% and 3.6%, respectively. Abnormal test results were the only multivariate indicator of both hard events (hazard ratio, 3.69; 95% CI, 1.54-8.80) and MACEs (hazard ratio, 6.12; 95% CI, 3.22-11.62).

Conclusions: Abnormal test results were obtained in one of four cases and were a strong and independent predictor of future hard events and MACEs.

Keywords: Asymptomatic; Coronary flow velocity reserve; Diabetes; Dipyridamole stress echocardiography; Screening; Transthoracic Doppler.

Publication types

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

MeSH terms

Aged
Asymptomatic Diseases / mortality*
Causality
Comorbidity
Coronary Artery Disease / diagnostic imaging*
Coronary Artery Disease / mortality*
Diabetes Complications / diagnostic imaging*
Diabetes Complications / mortality*
Echocardiography, Stress / statistics & numerical data*
Female
Humans
Italy / epidemiology
Male
Multimodal Imaging / statistics & numerical data*
Prevalence
Prognosis
Reproducibility of Results
Risk Assessment / methods
Risk Factors
Sensitivity and Specificity
Survival Analysis