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OBJECTIVE-To determine the incremental prognostic value of dobutamine stress echocardiography (DSE) at 13-year follow-up (SD 3.2 years) for predicting mortality and cardiac events in diabetic patients. RESEARCH DESIGN AND METHODS-A total of 396 diabetic patients (mean age 61 11 years; 252 men [64%]) with limited exercise capacity who underwent DSE for evaluation of ischemia were studied. End points were all causes of mortality, cardiac death, and hard cardiac events (cardiac death and nonfatal myocardial infarction). RESULTS-During a mean follow-up of 13 years, 230 patients (58%) died (1 2 1 cardiac deaths), and 30 patients had nonfatal myocardial infarction. Cumulative survival in patients with an abnormal DSE at 5, 10, and 15 years was 68, 49, and 41%, respectively. In patients with a normal DSE, these respective numbers were 74, 57, and 44%. Multivariate analyses showed that DSE provided incremental value over clinical characteristics and stress test parameters for prediction of mortality and cardiac even CONCLUSIONS-DSE provided restricted predictive value of adverse outcome in patients with diabetes who were unable to perform an adequate exercise stress test. DSE provided optimal risk stratification up to 7 years after initial testing. Repeated DSE at that time might add to its prognostic value Diabetes Care 35:634-639,2012

The presence of myocardial ischemia during dobutamine stress echocardiography is independently associated with an increased risk of all-cause mortality in women after adjustment for clinical data. This association is observed in patients who have proved coronary artery disease and in patients who have no history of coronary artery disease.

Background. Dobutamine stress echocardiography (DSE) was shown to provide incremental prognostic information. However, its role in the prediction of mortality in elderly persons is not well defined. We assessed the value of DSE in the prediction of mortality and hard cardiac events during long-term follow-up in patients older than 65 years. Methods. We studied 1434 patients .65 years old (mean age 72 6 3 years) who underwent DSE for evaluation of coronary artery disease. Ischemia was defined as new or worsening wall motion abnormalities. Follow-up events were total mortality and hard cardiac events (cardiac mortality and nonfatal myocardial infarction). Multivariable Cox regression analysis was used to identify the independent predictors of follow-up events. Results. Ischemia was detected in 675 patients (47%). Five hundred six patients (35%) had a normal study, and 253 (18%) had fixed wall motion abnormalities. During a mean follow-up of 6.5 years, 532 (37%) deaths occurred, of which 249 (17%) were due to cardiac causes. A nonfatal myocardial infarction occurred in 45 patients (3%). Independent predictors of all-cause mortality in a multivariate analysis model were age (hazard ratio [HR] 1.06; 95% confidence interval [CI], 1.05‐1.08), male sex (HR 1.5; 95% CI, 1.2‐1.8), hypertension (HR 1.2; 95% CI, 1.1‐1.4), smoking (HR 1.3; 95% CI, 1.1‐1.6), diabetes (HR 1.4; 95% CI, 1.1‐1.8), rest wall motion abnormalities (HR 1.07; 95% CI, 1.06‐1.09), and ischemia (HR 1.3; 95% CI, 1.1‐1.6). Independent predictors of hard cardiac events were age (HR 1.07; 95% CI, 1.05‐1.09), male sex (HR 1.3; 95% CI, 1.1‐1.7), smoking (HR 1.3; 95% CI, 1.1‐1.6), diabetes (HR 1.6; 95% CI, 1.2‐2.2), rest wall motion abnormalities (HR 1.13; 95% CI, 1.12‐1.16), and ischemia (HR 2.1; 95% CI, 1.5‐2.8). Conclusion. DSE provides independent prognostic information to predict all-cause mortality and hard cardiac events in elderly patients.