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Prediction of cardiovascular events in clinically selected high-risk NIDDM patients. Prognostic value of exercise stress test and thallium-201 single-photon emission computed tomography.
Vanzetto, G; Halimi, S; Hammoud, T; Fagret, D; Benhamou, P Y; Cordonnier, D; Denis, B; Machecourt, J.
Afiliação
  • Vanzetto G; Department of Cardiology, University Hospital, Grenoble, France. gerald.vanzetto@ujf-grenoble.fr
Diabetes Care ; 22(1): 19-26, 1999 Jan.
Article em En | MEDLINE | ID: mdl-10333898
OBJECTIVE: We evaluated the prognostic value of an exercise stress test and thallium-201 scintigraphy for the prediction of cardiac events in selected high-risk NIDDM patients. RESEARCH DESIGN AND METHODS: NIDDM patients (n = 158, 105 men, aged 63 +/- 9 years) with two or more of the following criteria were prospectively included: age > or = 65 years, active smoking, hypertension > 160/95 mmHg, hypercholesterolemia (cholesterol > 5.70 mmol/l or LDL > 3.10 mmol/l), peripheral artery disease, abnormal rest electrocardiogram, or microalbuminuria (20-200 micrograms/min). An exercise-stress scintigraphy was performed in 77 patients able to exercise, while a dipyridamole scintigraphy was performed in 80 patients unable to exercise. Follow-up was 23 +/- 17 months. Major end points were cardiac deaths or nonfatal myocardial infarction. RESULTS: The annual event rate was 7.31% (deaths: 8, myocardial infarction: 14). Independent predictors of events were as follows: an age > 60 (P = 0.02), an abnormal rest electrocardiogram (P = 0.02), microalbuminuria (P = 0.001), the inability to exercise (P = 0.009), and the presence of more than two defects on scintigraphy (P = 0.001). A cardiac death occurred in 1.3% of patients able to exercise versus 8.8% of patients unable to exercise (odds ratio = 6.8, P = 0.001). Among patients unable to exercise, large perfusion defects corresponded to an annual mortality rate of 22.3%. Conversely, the negative predictive value of a normal scintigraphy for the occurrence of death was 97%. CONCLUSIONS: Inability to exercise and large perfusion defects on thallium-201 scan are major predictors of future death and myocardial infarction in high-risk NIDDM patients.
Assuntos
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Bases de dados: MEDLINE Assunto principal: Doenças Cardiovasculares / Tomografia Computadorizada de Emissão de Fóton Único / Morte Súbita Cardíaca / Diabetes Mellitus Tipo 2 / Teste de Esforço / Coração / Infarto do Miocárdio Tipo de estudo: Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Diabetes Care Ano de publicação: 1999 Tipo de documento: Article País de afiliação: França
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Bases de dados: MEDLINE Assunto principal: Doenças Cardiovasculares / Tomografia Computadorizada de Emissão de Fóton Único / Morte Súbita Cardíaca / Diabetes Mellitus Tipo 2 / Teste de Esforço / Coração / Infarto do Miocárdio Tipo de estudo: Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Diabetes Care Ano de publicação: 1999 Tipo de documento: Article País de afiliação: França