Dobutamine stress myocardial perfusion imaging: 8-year outcomes in patients with diabetes mellitus. (19th January 2016)

• Record Type: Journal Article
• Authors: Boiten, Hendrik J.; van Domburg, Ron T.; Valkema, Roelf; Zijlstra, Felix; Schinkel, Arend F.L.
• Is Part Of: European heart journal. Volume 17:Number 8(2016:Aug.)
• Page Start: 871
• Page End: 876
• Publication Date: 2016-01-19
• Subjects: myocardial perfusion imaging -- diabetes mellitus -- long-term prognosis -- SPECT; Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.10754
• DOI: 10.1093/ehjci/jev351
• Languages: English
• ISSNs: 2047-2404

Abstract

Abstract: Aims: Many studies have examined the prognostic value of myocardial perfusion imaging (MPI) using single-photon emission computed tomography (SPECT) for the prediction of short- to medium-term outcomes. However, the long-term prognostic value of MPI in patients with diabetes mellitus remains unclear. Therefore, this study assessed the long-term prognostic value of MPI in a high-risk cohort of patients with diabetes mellitus. Methods and results: A high-risk cohort of 207 patients with diabetes mellitus who were unable to undergo exercise testing underwent dobutamine stress MPI. Follow-up was successful in 206 patients; 12 patients were excluded due to early revascularization. The current data are based on the remaining 194 patients. Follow-up end points were all-cause mortality, cardiac mortality, and nonfatal myocardial infarction. The Kaplan–Meier survival curves were constructed, and univariable and multivariable analyses were performed to identify predictors of long-term outcome. During a mean follow-up of 8.1 ± 5.9 years, 134 (69%) patients died of which 68 (35%) died due to cardiac causes. Nonfatal myocardial infarction occurred in 24 patients (12%), and late (>60 days) coronary revascularization was performed in 61 (13%) patients. Survival analysis showed that MPI provided optimal risk stratification up to 4 years after testing. After that period, the outcome was comparable in patients with normal and abnormal MPI. Multivariable analyses showed that MPI provided incremental prognostic value up to 4 years after testing. Conclusion: In high-risk patients with diabetes mellitus, dobutamine MPI provides incremental prognostic information in addition to clinical data for a 4-year period after testing.