Long-term predictive value restricted for patients with diabetes unable to take an exercise stress test
TUESDAY, Jan. 10 (HealthDay News) -- Dobutamine stress echocardiography (DSE) has limited long-term predictive value for patients with diabetes who are unable to perform an exercise stress test, particularly during the first seven years after initial testing, according to a study published online Jan. 6 in Diabetes Care.
Jors N. van der Sijde, from the Erasmus Medical Center in Rotterdam, Netherlands, and colleagues investigated the prognostic value of DSE for predicting mortality and cardiac events in 396 patients with diabetes. Participants (mean age, 61 years) with limited exercise capacity underwent DSE for evaluation of ischemia, and were followed for a mean of 13 years. The study end points included all-cause mortality, cardiac death, and cardiac events (death and nonfatal myocardial infarction).
The investigators found that, during follow-up, 230 patients died, including 121 cardiac deaths, and nonfatal myocardial infarction occurred in 30 patients. For patients with abnormal DSE at five, 10, and 15 years, cumulative survival was 68, 49, and 41 percent, respectively, compared with 74, 57, and 44 percent, respectively, for those with normal DSE. DSE provided increased value over clinical characteristics and stress test parameters for prediction of death and cardiac events, on multivariable analysis. Optimal risk stratification with DSE was seen up to seven years after initial testing, after which the risk of adverse outcome increased comparably in both normal and abnormal DSE patients.
"DSE provided optimal risk stratification up to seven years after initial testing," the authors write. "Repeated DSE at that time might add to its prognostic value."
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