Prognostic stratification of diabetic patients by exercise echocardiography

OBJECTIVES The aim of this study was to assess the incremental value of exercise echocardiography for the risk stratification of diabetic patients. BACKGROUND There are currently insufficient outcome data in diabetic patients 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 known or suspected ischemic heart disease (IHD). RESULTS Cardiac events occurred in 50 patients (cardiac death in 23 and nonfatal 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 those with abnormal exercise echocardiography at one year (0% vs. 1.9%), three years (1.8% vs. 11.9%), and five years (7.6% vs. 23.3%), respectively (p = 0.0001). Patients with multivessel distribution of echocardiographic abnormalities had the highest event rate (2.9% at one year, 15.2% at three years, and 32.8% at five years). In an incremental multivariate analysis model, exercise echocardiography increased the chi-square of the clinical and exercise ECG model from 29 to 44.8 (p = 0.0001). CONCLUSIONS Exercise echocardiography provides incremental data for risk stratification of diabetic patients with known or suspected IHD. Patients with a normal exercise echocardiogram have a low event rate. Patients with multivessel distribution of exercise echocardiographic abnormalities are at the highest risk of cardiac events, as one-third of these patients experience cardiac death or nonfatal MI during the five years following exercise echocardiography.