Abstract 3761: Diabetic Patients with Abnormal Stress Echocardiography have worse Prognosis Compared to Patients with Known Coronary Artery Disease: A Stress Echocardiography Study
Background: Patients with diabetes mellitus (DM) are considered as CAD risk equivalents and are at high-risk for future cardiovascular events. However, the role of stress echocardiography in this high-risk subgroup in comparison with those with established CAD is not well defined.
Methods: We evaluated 3258 consecutive patients (mean age 60±13 years; 48% men) undergoing stress echocardiography (59% dobutamine). Patients were divided into 3 groups based on the stress wall motion score index (WMSI) 1=normal; 1.1–1.7=mild to moderately abnomal and >1.7= markedly abnormal. Follow up (2.7 ± 1.1 years) for confirmed nonfatal MI and cardiac death (n=170) were obtained.
Results: Among the 3258 patients undergoing stress echocardiography, 1824 (56%) patients had no DM or CAD, 464 (14%) patients had no DM but with CAD while 943 (29%) patients had DM. In the presence of a normal stress echocardiography study all the three groups had a benign prognosis. However in the presence of an abnormal stress echocardiography, patients with DM had worse prognosis both at mild-moderately abnormal stress echo study (Event rate 1.6%, 2.9% and 3.7%/y respectively) and markedly abnormal stress echo study (Event rate 4.0%, 4.8% and 7.4%/y respectively). The event rate in diabetics was worse than those with know CAD (Figure⇓).
Conclusions: A normal stress echocardiography study portends a benign prognosis in both DM and non-DM with or without CAD. However, a markedly abnormal stress echocardiography study has a worse prognosis in diabetics even when compared to patients with known CAD.