Can Dobutamine Stress Echocardiography Predict Cardiac Events in Nonrevascularized Diabetic Patients Following Acute Myocardial Infarction: DSE in Detecting Myocardial Ischemia in Diabetic Patients
DSE in Detecting Myocardial Ischemia in Diabetic Patients
Previously, Calnon et al found that the ischemic pattern induced by dobutamine stress in subjects with more severe coronary disease is characterized as “failure to increase systolic thickening during dobutamine stress”. Lu et al also found that DSE results are associated not only with stenosis severity but also, even more importantly, with lesion morphology. Furthermore, many investigators who evaluated the prediction of multivessel disease by DSE in patients with resting left ventricular asynergy consistently reported a high specificity but a low and markedly varied sensitivity. These findings suggest that the diagnostic value of DSE using the present criteria of detecting myocardial ischemia is not satisfactory, and could explain why the rate of positive DSE results was similar between the two groups, despite a higher frequency of triple vessel disease and a trend of more left ventricular asynergic segment in diabetic than in nondiabetic patients. buy birth control online
DSE in Predicting Future Events in Diabetic Patients
Many investigators have found that coronary atherosclerotic lesions are not only prone to narrowing, but also tend to become unstable or develop into coronary occlusions in patients with diabetes.- Furthermore, in patients after uncomplicated AMI, a history of diabetes mellitus, regardless of DSE positivity, has also been shown to be an independent predictor of future spontaneous cardiac events.
These findings suggest that hard events (eg, AMI or cardiac death) would be prone to occur in diabetic patients. Our data show that the only significant role of DSE in diabetic patients is for predicting future unstable angina; however, the predictive value is not as good as in the nondiabetic group. This might have been due to a higher incidence of silent angina in diabetic patients.