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01.12.2009 | Research | Ausgabe 1/2009 Open Access

Cardiovascular Ultrasound 1/2009

Prognostic value of exercise echocardiography in diabetic patients

Zeitschrift:
Cardiovascular Ultrasound > Ausgabe 1/2009
Autoren:
Joselina LM Oliveira, José AS Barreto-Filho, Carla RP Oliveira, Thaiana A Santana, Fernando D Anjos-Andrade, Érica O Alves, Adão C Nascimento-Junior, Thiago JS Góes, Nathalie O Santana, Francis L Vasconcelos, Martha A Barreto, Argemiro D'Oliveira Junior, Roberto Salvatori, Manuel H Aguiar-Oliveira, Antônio CS Sousa
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1476-7120-7-24) contains supplementary material, which is available to authorized users.
José AS Barreto-Filho, Carla RP Oliveira, Thaiana A Santana, Fernando D Anjos-Andrade, Érica O Alves, Adão C Nascimento-Junior, Thiago JS Góes, Nathalie O Santana, Francis L Vasconcelos, Martha A Barreto, Argemiro D'Oliveira Junior, Roberto Salvatori, Manuel H Aguiar-Oliveira and Antônio CS Sousa contributed equally to this work.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

All authors contributed to this work, read and approved the final manuscript.

Abstract

Background

Coronary artery disease (CAD) is the leading cause of death in diabetic patients. Although exercise echocardiography (EE) is established as a useful method for diagnosis and stratification of risk for CAD in the general population, there are few studies on its value as a prognostic tool in diabetic patients. The purpose of this investigation was to evaluate the value of EE in predicting cardiac events in diabetics.

Methods

193 diabetic patients, 97 males, 59.8 ± 9.3 yrs (mean ± SD) were submitted to EE between 2001 and 2006 and followed from 7 to 65 months with median of 29 months by phone calls and personal interviews with patients and their primary physician, and reviewing medical records and death certificates. The end points were cardiac events, defined as non-fatal myocardial infarction, late myocardial revascularization and cardiac death. Sudden death without another explanation was considered cardiac death. Survival free of end points was estimated by the Kaplan-Meier method.

Results

Twenty-six cardiac events were registered in 24 individuals during the follow-up. The rates of cardiac events were 20.6 and 7% in patients with positive and negative EE, respectively (p < 0.001). Predictors of cardiac events included sedentary lifestyle, with RR of 2.57 95%CI [1.09 to 6.02] (P = 0.03) and positive EE, with RR 3.63, 95%CI [1.44 to 9.16] (P = 0.01). Patients with positive EE presented higher rates of cardiac events at 12 months (6.8% vs. 2.2%), p = 0.004.

Conclusion

EE is a useful method to predict cardiac events in diabetic patients with suspected or known CAD.
Zusatzmaterial
Additional file 1: RS, female patient, 73 years-old, active, BMI = 21 kg/m 2 , complaining of typical chest pain, hypertensive, with family history of coronary artery disease and previous exercise testing negative for myocardial ischemia. In exercise echocardiography, left ventricular mass index = 106.1 g/m2. Ejection fraction = 0.69, peak exercise heart rate = 145 beats/min, WMSI in peak exercise = 1.13. Time spent in treadmill exercise = 6.57 minutes, 2.5 mph, achieved second stage in Bruce protocol. In peak exercise, presented hypokinesis in anterior and lateral-apical walls. (WMV 4 MB)
12947_2008_271_MOESM1_ESM.wmv
Additional file 2: ILA,female patient, 61 years-old, active, BMI = 29.9 kg/m 2 , complaining of atypical chest pain, hypertensive, dyslipidemic, with family history of coronary artery disease and previous exercise testing negative for myocardial ischemia. In exercise echocardiography, left ventricular mass index = 88.5 g/m2, ejection fraction = 0.69, peak exercise heart rate = 150 beats/min, WMSI in peak exercise = 1.13. time spent in treadmill exercise = 9 minutes, 3.4 mph, achieved the third stage of Bruce protocol. In peak exercise, presented hypokinesis in anterior and lateral-apical walls. (WMV 8 MB)
12947_2008_271_MOESM2_ESM.wmv
Additional file 4: JCA male patient, 43 years-old, active, BMI = 22.46 kg/m 2 . History of myocardial infarction three years ago, complaining of atypical chest pain, hypertensive, dyslipidemic, with family history of coronary artery disease and precious exercise testing negative for myocardial ischemia. In exercise echocardiography, presented left ventricular mass index = 114.8 g/m2, ejection fraction = 0.56, peak exercise heart rate = 183 beats/min, WMSI in peak exercise = 1.13. Time spent in treadmill exercise = 12.53 minutes, 5.0 mph, achieved the fifth stage in Bruce protocol. Both at rest and in peak exercise presented hypokinesis in inferior-basal and inferior-medial walls. (WMV 5 MB)
12947_2008_271_MOESM4_ESM.wmv
Additional file 5: Output of statistical analyses performed in SPSS 13.0. (DOC 1 MB)
12947_2008_271_MOESM5_ESM.doc
Authors’ original file for figure 1
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Authors’ original file for figure 2
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Authors’ original file for figure 3
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Authors’ original file for figure 4
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