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European Journal of Heart Failure 2007 9(10):1038-1043; doi:10.1016/j.ejheart.2007.07.002
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© 2007 European Society of Cardiology

Dobutamine stress echocardiography and the effect of revascularization on outcome in diabetic and non-diabetic patients with chronic ischaemic left ventricular dysfunction

Lauro Cortigiania,*, Rosa Sicarib, Alessandro Desideric, Riccardo Bigid, Francesco Bovenzia, Eugenio Picanob on behalf of the VIDA (Viability Identification with Dobutamine Administration) Study Group

a Division of Cardiology, Hospital "Campo di Marte" Lucca, 55032 Lucca, Italy
b CNR, Institute of Clinical Physiology Pisa, Italy
c Cardiovascular Research Foundation, S. Giacomo Hospital Castelfranco Veneto, Italy
d Cardiology, Department of Medicine and Surgery, University School of Medicine Milan, Italy

* Corresponding author. Tel.: +39 583 970450; fax: +39 583 970445. E-mail address: lacortig{at}tin.it (L. Cortigiani).


  Abstract

Aim: To evaluate the interaction between prognostic effect of revascularization and viability in diabetic and non-diabetic patients with ischaemic left ventricular dysfunction.

Methods: 612 patients with angiographically proven coronary artery disease and left ventricular ejection fraction <35% underwent dobutamine stress echocardiography to assess viability (peak-rest wall motion score index >0.4). 262 patients (75 diabetics, 187 non-diabetics) underwent revascularization and 350 (88 diabetics, 262 non-diabetics) were on medical therapy.

Results: During follow-up 215 patients died. Independent predictors of mortality in revascularized patients were resting left ventricular ejection fraction (HR=0.93, 95% CI 0.89–0.97, p<0.0001), {Delta} WMSI>40 (HR=0.44, 95% CI 0.23–0.85, p=0.01), and age (HR=1.03, 95% CI 1.00–1.06, p=0.04). In medically treated patients, independent predictors of mortality were diabetes mellitus (HR=1.64, 95% CI 1.13–2.38, p=0.009), number of diseased vessels (HR=1.27, 95% CI 1.03–1.56, p=0.02), and age (HR–1.02, 95% CI 1.00=1.04, p–0.03). In revascularized patients, 4-year mortality was 15% in those with viability and 26% in those without viability (p=0.04), there was no difference between diabetics and non-diabetics (24% vs 22%; p=0.24).

Conclusions: Viability at dobutamine stress echocardiography independently predicts improved outcome following revascularization in non-diabetics as well as diabetic patients with ischaemic left ventricular dysfunction.

Key Words: Diabetes mellitus • Stress echocardiography • Coronary artery disease • Prognosis

Received February 14, 2007; Revised May 8, 2007; Accepted July 2, 2007


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