Dobutamine stress echocardiography in patients with diabetes mellitus: Enhanced prognostic prediction using a simple risk score

Nithima Chaowalit, Ana Lucia Arruda, Robert B. McCully, Kent R Bailey, Patricia Pellikka

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

OBJECTIVES: We sought to determine the prognostic value of dobutamine stress echocardiography (DSE) for predicting long-term outcomes in a large cohort with diabetes mellitus and to develop a simple risk score using clinical and echocardiographic data. BACKGROUND: Neither risk scores nor long-term prognostic value of DSE has been described in a large diabetic population. METHODS: We studied 2,349 patients with diabetes mellitus (1,338 men, 67 ± 11 years of age) during a follow-up of 5.4 ± 2.2 years. RESULTS: Mortality and morbidity (myocardial infarction and late coronary revascularization) occurred in 1,044 (44%) and 309 (13%) patients, respectively. Addition of stress echocardiographic variables to the clinical and rest echocardiographic model provided incremental prognostic information for predicting mortality (chi-square = 243 to 270, p < 0.0001) and morbidity (chi-square = 38 to 78, p < 0.0001). For each end point, a simple risk score was derived according to the estimated values of beta coefficients of multivariate predictors (insulin therapy, smoking, failure to achieve target heart rate, percentage of ischemic segments, and impaired left ventricular systolic function) and resulted in an assessment of risk among all age groups. The C-statistic values were 0.60 to 0.64, indicating modest discrimination. The estimated five-year event-free survivals of patients in three risk categories were 94%, 86%, and 80% for morbidity (p < 0.00001) and 69%, 60%, and 47% for mortality (p < 0.0001). CONCLUSIONS: In patients with diabetes mellitus, a simple and practical risk score using clinical variables and results of DSE stratified patients into three risk groups for mortality and cardiovascular morbidity.

Original languageEnglish (US)
Pages (from-to)1029-1036
Number of pages8
JournalJournal of the American College of Cardiology
Volume47
Issue number5
DOIs
StatePublished - Mar 7 2006

Fingerprint

Stress Echocardiography
Diabetes Mellitus
Morbidity
Mortality
Left Ventricular Function
Disease-Free Survival
Age Groups
Heart Rate
Smoking
Myocardial Infarction
Insulin
Population

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Dobutamine stress echocardiography in patients with diabetes mellitus : Enhanced prognostic prediction using a simple risk score. / Chaowalit, Nithima; Arruda, Ana Lucia; McCully, Robert B.; Bailey, Kent R; Pellikka, Patricia.

In: Journal of the American College of Cardiology, Vol. 47, No. 5, 07.03.2006, p. 1029-1036.

Research output: Contribution to journalArticle

@article{739e08749d8b48f68bf88a528412c6ea,
title = "Dobutamine stress echocardiography in patients with diabetes mellitus: Enhanced prognostic prediction using a simple risk score",
abstract = "OBJECTIVES: We sought to determine the prognostic value of dobutamine stress echocardiography (DSE) for predicting long-term outcomes in a large cohort with diabetes mellitus and to develop a simple risk score using clinical and echocardiographic data. BACKGROUND: Neither risk scores nor long-term prognostic value of DSE has been described in a large diabetic population. METHODS: We studied 2,349 patients with diabetes mellitus (1,338 men, 67 ± 11 years of age) during a follow-up of 5.4 ± 2.2 years. RESULTS: Mortality and morbidity (myocardial infarction and late coronary revascularization) occurred in 1,044 (44{\%}) and 309 (13{\%}) patients, respectively. Addition of stress echocardiographic variables to the clinical and rest echocardiographic model provided incremental prognostic information for predicting mortality (chi-square = 243 to 270, p < 0.0001) and morbidity (chi-square = 38 to 78, p < 0.0001). For each end point, a simple risk score was derived according to the estimated values of beta coefficients of multivariate predictors (insulin therapy, smoking, failure to achieve target heart rate, percentage of ischemic segments, and impaired left ventricular systolic function) and resulted in an assessment of risk among all age groups. The C-statistic values were 0.60 to 0.64, indicating modest discrimination. The estimated five-year event-free survivals of patients in three risk categories were 94{\%}, 86{\%}, and 80{\%} for morbidity (p < 0.00001) and 69{\%}, 60{\%}, and 47{\%} for mortality (p < 0.0001). CONCLUSIONS: In patients with diabetes mellitus, a simple and practical risk score using clinical variables and results of DSE stratified patients into three risk groups for mortality and cardiovascular morbidity.",
author = "Nithima Chaowalit and Arruda, {Ana Lucia} and McCully, {Robert B.} and Bailey, {Kent R} and Patricia Pellikka",
year = "2006",
month = "3",
day = "7",
doi = "10.1016/j.jacc.2005.10.048",
language = "English (US)",
volume = "47",
pages = "1029--1036",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "5",

}

TY - JOUR

T1 - Dobutamine stress echocardiography in patients with diabetes mellitus

T2 - Enhanced prognostic prediction using a simple risk score

AU - Chaowalit, Nithima

AU - Arruda, Ana Lucia

AU - McCully, Robert B.

AU - Bailey, Kent R

AU - Pellikka, Patricia

PY - 2006/3/7

Y1 - 2006/3/7

N2 - OBJECTIVES: We sought to determine the prognostic value of dobutamine stress echocardiography (DSE) for predicting long-term outcomes in a large cohort with diabetes mellitus and to develop a simple risk score using clinical and echocardiographic data. BACKGROUND: Neither risk scores nor long-term prognostic value of DSE has been described in a large diabetic population. METHODS: We studied 2,349 patients with diabetes mellitus (1,338 men, 67 ± 11 years of age) during a follow-up of 5.4 ± 2.2 years. RESULTS: Mortality and morbidity (myocardial infarction and late coronary revascularization) occurred in 1,044 (44%) and 309 (13%) patients, respectively. Addition of stress echocardiographic variables to the clinical and rest echocardiographic model provided incremental prognostic information for predicting mortality (chi-square = 243 to 270, p < 0.0001) and morbidity (chi-square = 38 to 78, p < 0.0001). For each end point, a simple risk score was derived according to the estimated values of beta coefficients of multivariate predictors (insulin therapy, smoking, failure to achieve target heart rate, percentage of ischemic segments, and impaired left ventricular systolic function) and resulted in an assessment of risk among all age groups. The C-statistic values were 0.60 to 0.64, indicating modest discrimination. The estimated five-year event-free survivals of patients in three risk categories were 94%, 86%, and 80% for morbidity (p < 0.00001) and 69%, 60%, and 47% for mortality (p < 0.0001). CONCLUSIONS: In patients with diabetes mellitus, a simple and practical risk score using clinical variables and results of DSE stratified patients into three risk groups for mortality and cardiovascular morbidity.

AB - OBJECTIVES: We sought to determine the prognostic value of dobutamine stress echocardiography (DSE) for predicting long-term outcomes in a large cohort with diabetes mellitus and to develop a simple risk score using clinical and echocardiographic data. BACKGROUND: Neither risk scores nor long-term prognostic value of DSE has been described in a large diabetic population. METHODS: We studied 2,349 patients with diabetes mellitus (1,338 men, 67 ± 11 years of age) during a follow-up of 5.4 ± 2.2 years. RESULTS: Mortality and morbidity (myocardial infarction and late coronary revascularization) occurred in 1,044 (44%) and 309 (13%) patients, respectively. Addition of stress echocardiographic variables to the clinical and rest echocardiographic model provided incremental prognostic information for predicting mortality (chi-square = 243 to 270, p < 0.0001) and morbidity (chi-square = 38 to 78, p < 0.0001). For each end point, a simple risk score was derived according to the estimated values of beta coefficients of multivariate predictors (insulin therapy, smoking, failure to achieve target heart rate, percentage of ischemic segments, and impaired left ventricular systolic function) and resulted in an assessment of risk among all age groups. The C-statistic values were 0.60 to 0.64, indicating modest discrimination. The estimated five-year event-free survivals of patients in three risk categories were 94%, 86%, and 80% for morbidity (p < 0.00001) and 69%, 60%, and 47% for mortality (p < 0.0001). CONCLUSIONS: In patients with diabetes mellitus, a simple and practical risk score using clinical variables and results of DSE stratified patients into three risk groups for mortality and cardiovascular morbidity.

UR - http://www.scopus.com/inward/record.url?scp=33644623159&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33644623159&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2005.10.048

DO - 10.1016/j.jacc.2005.10.048

M3 - Article

C2 - 16516089

AN - SCOPUS:33644623159

VL - 47

SP - 1029

EP - 1036

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 5

ER -