Introduction: Patients with diabetes mellitus (DM) have a high risk of cardiovascular (CV) events, such as myocardial infarction, revascularization or cardiac mortality. Coronary artery disease installs silently in this subgroup of patients, so pharmacological stress echocardiography (PSE) stands out as the method of choice in the diagnosis of coronary artery disease and prediction of CV events in diabetic population.
Aim: Evaluate the value of PSE in the stratification of prognosis in diabetic patients with suspected or diagnosed coronary heart disease.
Methods: Retrospective study including 297 patients with DM, who performed PES (dipyridamole or dobutamine) between 2010 and 2015. Demographic data, clinical, electrocardiographic, baseline and stress echocardiographic findings were collected to identify predictors of prognosis. We defined a combined endpoint of CV events, composed by cardiac death non-fatal, myocardial infarction non fatal and percutaneous or surgical revascularization.
Results: 194 patients (65.3%) were male and the mean age was 66±9 years. Cardiovascular risk factors were identified such as dyslipidemia (85.2%), arterial hypertension (89.9%), obesity (36.7%) and smoking (7.7%). We found history of myocardial infarction in 42.8%, angioplasty in 22.5% and bypass surgery in 12.8%. Left ventricular systolic dysfunction was detected on basal echocardiogram in 27.3% of cases. PES was performed in 55.9% of patients due to suspected coronary artery disease and in 44.1% due to diagnosed coronary heart disease. PES was performed with dobutamine in 68% and dipyridamole in 32% of patients. PES was positive in 15.2%, negative in 74.1% and inconclusive in 10.8% of patients. Mean follow-up was 2.6 years (±1.53). CV events occurred in 15.1% of patients. Using a multivariate regression analysis we identified as independent predictors of CV events the positivity of PES (p<0.001, OR 6.9, 95% 2,4-20,1), the chronic renal failure (p=0.005, OR 4.7, 95% CI 1,61-13,73) and the occurrence chest pain after PES (p=0.007, OR 3.6, 95% 1,4-9,3).
Conclusion: In this study, PES was an important independent predictor of CV events in patients with DM.