Prognostic stratification of diabetic patients by exercise echocardiography

OBJECTIVES The aim of this study was to assess the incremental value of exe rcise echocardiography for the risk stratification of diabetic patients. BACKGROUND There are currently insufficient outcome data in diabetic patien ts 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 kn own or suspected ischemic heart disease (IHD). RESULTS Cardiac events occurred in 50 patients (cardiac death in 23 and non fatal 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 t hose with abnormal exercise echocardiography at one year (0% vs. 1.9%), thr ee years (1.8% vs. 11.9%), and five years (7.6% vs. 23.3%), respectively (p = 0.0001). Patients with multivessel distribution of echocardiographic abn ormalities had the highest event rate (2.9% at one year, 15.2% at three yea rs, and 32.8% at five years). In an incremental multivariate analysis model , exercise echocardiography increased the chi-square of the clinical and ex ercise ECC model from 29 to 44.8 (p = 0.0001). CONCLUSIONS Exercise echocardiography provides incremental data for risk st ratification of diabetic patients with known or suspected IHD. Patients wit h a normal exercise echocardiogram have a low event rate. Patients with mul tivessel distribution of exercise echocardiographic abnormalities are at th e highest risk of cardiac events, as one-third of these patients experience cardiac death or nonfatal MI during the five years following exercise echo cardiography. (J Am Coll Cardiol 2001;37:1551-7) (C) 2001 by the American C ollege of Cardiology.