Prognostic Value of Dobutamine Stress Echocardiography in Patients With Diabetes

OBJECTIVE — The aim of this study was to assess the incremental value of dobutamine stress echocardiography (DSE) for the risk stratification of diabetic patients who are unable to perform an adequate exercise stress test. Exercise capacity is frequently impaired in patients with diabe-tes. The role of pharmacologic stress echocardiography in the risk stratification of diabetic patients has not been well defined. RESEARCH DESIGN AND METHODS — We studied 396 diabetic patients (mean age 61 11 years, 252 men [64%]) with limited exercise capacity who underwent DSE for evalu-ation of known or suspected coronary artery disease (CAD). End points were hard cardiac events (cardiac death and nonfatal myocardial infarction) and all causes of mortality. RESULTS — During a median follow-up of 3 years, 97 patients (24%) died (55 cardiac deaths), and 27 patients had nonfatal myocardial infarction. In an incremental multivariate analysis model, clinical predictors of hard cardiac events were history of congestive heart failure, previous myocardial infarction, hypercholesterolemia, and ejection fraction at rest. The percent-age of ischemic segments was incremental to the clinical model in the prediction of hard cardiac events (2 37 vs. 18, P 0.05). Clinical predictors of all causes of mortality were history o