Dobutamine stress echocardiography and the effect of revascularization on outcome in diabetic and non-diabetic patients with chronic ischaemic left ventricular dysfunction.

Abstract

AIM:

To evaluate the interaction between prognostic effect of revascularization and viability in diabetic and non-diabetic patients with ischaemic left ventricular dysfunction.

METHODS:

612 patients with angiographically proven coronary artery disease and left ventricular ejection fraction <35% underwent dobutamine stress echocardiography to assess viability (peak-rest wall motion score index >0.4). 262 patients (75 diabetics, 187 non-diabetics) underwent revascularization and 350 (88 diabetics, 262 non-diabetics) were on medical therapy.

RESULTS:

During follow-up 215 patients died. Independent predictors of mortality in revascularized patients were resting left ventricular ejection fraction (HR=0.93, 95% CI 0.89-0.97, p<0.0001), Delta WMSI>40 (HR=0.44, 95% CI 0.23-0.85, p=0.01), and age (HR=1.03, 95% CI 1.00-1.06, p=0.04). In medically treated patients, independent predictors of mortality were diabetes mellitus (HR=1.64, 95% CI 1.13-2.38, p=0.009), number of diseased vessels (HR=1.27, 95% CI 1.03-1.56, p=0.02), and age (HR=1.02, 95% CI 1.00-1.04, p=0.03). In revascularized patients, 4-year mortality was 15% in those with viability and 26% in those without viability (p=0.04), there was no difference between diabetics and non-diabetics (24% vs 22%; p=0.24).

CONCLUSIONS:

Viability at dobutamine stress echocardiography independently predicts improved outcome following revascularization in non-diabetics as well as diabetic patients with ischaemic left ventricular dysfunction.

• Authors: Lauro Cortigiani, Rosa Sicari, Alessandro Desideri, Riccardo Bigi, Francesco Bovenzi, Eugenio Picano, VIDA (Viability Identification with Dobutamine Administration) Study Group
• Journal: European journal of heart failure (Eur J Heart Fail) Vol. 9 Issue 10 Pg. 1038-43 (Oct 2007) ISSN: 1388-9842 [Print] England
• PMID: 17707132 (Publication Type: Journal Article, Multicenter Study)

Topics

• Case-Control Studies
• Chronic Disease
• Coronary Artery Disease (diagnostic imaging, physiopathology)
• Diabetes Mellitus
• Echocardiography, Stress
• Female
• Humans
• Male
• Middle Aged
• Myocardial Ischemia (diagnostic imaging, mortality, therapy)
• Myocardial Revascularization
• Prognosis
• Prospective Studies
• Risk Factors
• Stroke Volume
• Survival Analysis
• Treatment Outcome
• Ventricular Dysfunction, Left (diagnostic imaging, mortality, therapy)