EVALUATION USING DOBUTAMINE STRESS ECHOCARDIOGRAPHY IN PATIENTS WITH INSULIN-DEPENDENT DIABETES-MELLITUS BEFORE KIDNEY AND OR PANCREAS TRANSPLANTATION/

The purpose of this study was to examine the ability of dobutamine str ess echocardiography to stratify patients with juvenile onset, insulin -dependent diabetes mellitus who are being considered for kidney and/o r pancreas transplantation, into high- or low-risk groups for future c ardiac events. Fifty-three such patients underwent dobutamine stress e chocardiography before kidney and/or pancreas transplantation. Cardiac events, including cardiac death, nonfatal myocardial infarction, unst able angina, pulmonary edema, and need for coronary revascularization, occurring between the time of the dobutamine stress echocardiogram an d the last patient follow-vp contact were retrospectively identified. Twenty patients (38%) had an abnormal dobutamine stress echocardiogmm. Eleven patients had 15 cardiac events over a mean +/- SD) follow-up p eriod of 418 +/- 269 days. Event rates were 45% among those with an ab normal, versus 6% among those with a normal dobutamine stress echocard iogram (p = 0.002). The result of the dobutamine stress test independe ntly predicted prognosis in a multivariate analysis (p = 0.003, odds r atio = 12.7). We conclude that dobutamine stress echocardiography accu rately stratifies patients with juvenile onset, insulin-dependent diab etes being considered for kidney and/or pancreas transplantation for r isk of future cardiac events.