Abstract 14842: Prognostic Value Of Combined Dobutamine Stress CMR And Late Gadolinium Enhancement In Patients With Diabetes Mellitus.
Background: Patients with diabetes mellitus are at high risk of cardiovascular events. Aim of this study was to assess the value of combined dobutamine stress cardiovascular magnetic resonance (DCMR) and late gadolinium enhancement (LGE) for prediction of cardiac events in patients with diabetes mellitus.
Methods: Clinical data and DCMR results were analyzed in 355 consecutive patients with diabetes mellitus undergoing DCMR between 2000 and 2009. Twenty seven patients who underwent early revascularisation (≤3 months) after the test were excluded from analysis. The remaining 318 patients (median age, 67 years) were followed up for a mean of 25 ± 12 months. Beside clinical data, wall motion abnormalities (WMA) at rest, the presence of stress-induced WMA (ischemia) and myocardial LGE were assessed for each patient. Cox proportional hazards regression models were used to identify independent predictors of the composite of cardiac events defined as cardiac death and non-fatal myocardial infarction.
Results: WMA at rest were observed in 123 patients (38.7%), 129 patients (40.6%) experienced an inducible WMA during testing and 138 patients (43.4%) demonstrated myocardial LGE. Twenty five cardiac events were reported. In univariate analysis, predictors of late cardiac events were resting WMA (hazard ratio (HR) 5.120; 95% confidence interval (CI) 2.044 to 12.826; p<0.001), stress-induced WMA on DCMR (HR 5.915, 95% CI 2.217 to 15.781; p<0.001) and myocardial LGE (HR 0.143, 95% CI 0.049 to 0.416; p<0.001). In multivariate analysis, stress-induced WMA on DCMR (HR 4.1, 95% CI 1.5 to 11.1; p=0.005) was an independent predictor of late cardiac events.
Conclusion: Myocardial ischaemia during DCMR is an independent predictor of cardiac events in patients with diabetes mellitus.Figure:Kaplan-Meier curve analysis showing the difference in mortality if patients with diabetes mellitus are stratified according to DCMR result.
- © 2011 by American Heart Association, Inc.