Can Dobutamine Stress Echocardiography Predict Cardiac Events in Nonrevascularized Diabetic Patients Following Acute Myocardial Infarction: DSE

Among the nondiabetic patients with cardiac death, DSE results were positive in 11 patients (6 died of reinfarction, 2 of progressive heart failure, and 3 sudden deaths) and were negative in 3 patients (2 died of progressive heart failure, and 1 of reinfarction). The frequencies of future reinfarction, unstable angina, and hard and all events were significantly greater in patients with positive DSE results than in those with negative DSE results (Table 2). In the 17 cases of reinfarction, the infarct location was predicted correctly by DSE in 13 cases but not in 4 cases (2 with positive test results and 2 with negative test results). The accuracy of DSE in predicting the reinfarct location in the nondiabetic group was slightly, but insignificantly, better than in the diabetic group (76% vs 60%, respectively; p = 0.415).
The cardiac-origin mortality rate in diabetic patients was slightly higher than in nondiabetic patients (10.5% vs 7.6%, respectively; p = 0.382), especially for deaths related to progressive heart failure (4.8% vs 2.1%, respectively; p = 0.215). The incidence of unstable angina and reinfarction in nondiabetic patients was insignificantly greater than in diabetic patients (30.8% vs 24.0%, respectively; p = 0.226).
In addition, the sensitivity, specificity, and positive and negative predictive values of DSE for the prediction of future cardiac events were higher in the nondiabetic group than in the diabetic group, although the differences were not statistically significant (all p > 0.05; Table 3).
Hard Events
From the univariate analysis model, peripheral arterial disease (p = 0.0006) and shorter dobut-amine time (p = 0.013) were associated with a lower event-free survival rate in diabetic patients, but a positive DSE result was not (p = 0.874; Fig 1 top, A). In nondiabetic patients, negative DSE results (p = 0.0008; Fig 1 bottom, B), lower peak stress WMSI (p = 0.002), lower number of diseased vessels (p = 0.003), higher ejection fraction (p = 0.005), treatment with tissue-type plasminogen activator (p = 0.014), lower Killip classification (p = 0.031), and nonanterior infarct (p = 0.042) were associated with a better event-free survival. Link

Table 3—Predictive Value of DSE for Future Cardiac E-vents

Events Sensitivity Specificity PositivePredictiveValue NegativePredictiveValue
All events
Diabetics, % 71.8 50.0 38.9 80.0
Nondiabetics, % 81.2 55.4 49.1 84.8
Hard events
Diabetics, % 58.8 43.7 16.9 84.4
Nondiabetics, % 83.3 46.6 18.8 94.9

 

Figure 1. Kaplan-Meier event-free survival curves for hard or total cardiac events in diabetic (top, A) or nondiabetic patients (bottom, B) according to DSE results. DM = diabetes mellitus; Non-DM = nondiabetes mellitus.

Figure 1. Kaplan-Meier event-free survival curves for hard or total cardiac events in diabetic (top, A) or nondiabetic patients (bottom, B) according to DSE results. DM = diabetes mellitus; Non-DM = nondiabetes mellitus.

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