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Use of dobutamine stress echocardiography in detecting silent myocardial ischaemia in asymptomatic diabetic patients: a comparison with thallium scintigraphy and exercise testing
Author(s) -
Penfornis A.,
Zimmermann C.,
Boumal D.,
Sabbah A.,
Meneveau N.,
GaultierBourgeois S.,
Bassand J. P.,
Bernard Y.
Publication year - 2001
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1046/j.1464-5491.2001.00599.x
Subject(s) - medicine , asymptomatic , coronary artery disease , dobutamine , cardiology , thallium , diabetes mellitus , scintigraphy , stress testing (software) , stress echocardiography , hemodynamics , inorganic chemistry , chemistry , computer science , programming language , endocrinology
Aims Silent myocardial ischaemia is frequent in diabetic patients. The aim of this study was to compare the efficacy of thallium‐201 single‐photon emission computed tomography ( 201 Tl SPECT) coupled with exercise stress testing (EST), and dobutamine stress echocardiography (DSE) in the detection of asymptomatic coronary artery disease. Methods Fifty‐six asymptomatic diabetic patients, with a known duration of diabetes > 15 years for Type 1 and > 5 years for Type 2, having at least three added risk factors, but without rest ECG abnormalities, were enrolled in this prospective study. All of them were submitted to DSE with a maximum infusion rate of 40 µg/kg per min dobutamine ± i.v. atropine, and to 201 Tl SPECT coupled with EST. Coronary angiography was performed if at least one test was abnormal. Results Diabetic patients were 37 males and 19 females, aged mean ( sd ) 60 ± 10 years, 10 Type 1 and 46 Type 2, with a known duration of disease of mean ( sd ) 17 ± 9 years. Feasibility of DSE was 91%. No serious complication occurred during the test. Coronary angiography was performed in 26 patients (47%); 17 were abnormal (30% of the whole group): six patients had a one‐vessel, six a two‐vessel and five a three‐vessel disease. Predictive positive value was 69% for DSE, 75% for 201 Tl SPECT and 60% for EST. DSE was falsely negative in four cases vs. eight for 201 Tl SPECT and nine for EST. Conclusions Asymptomatic coronary disease is common in diabetes associated with other risk factors. DSE appears useful in its detection and a good alternative to 201 Tl SPECT. Diabet. Med. 18, 900–905 (2001)