From the Division of Cardiology, San Luca Hospital, Lucca, Italy (L.C., L.B., F.B.); and Departments of Echocardiography (M.R., E.P, R.S.) and Epidemiology (S.M.), Institute of Clinical Physiology, CNR, Pisa, Italy.
Circ Cardiovasc Imaging. 2015 May;8(5). doi: 10.1161/CIRCIMAGING.114.002757.
To compare the capability by stress echocardiography results to predict overall mortality in a large unselected cohort of diabetic and nondiabetic patients.
The study group comprised 14 140 patients (2835 diabetics and 11 305 nondiabetics) who underwent stress echocardiography for evaluation of known (n=5671) or suspected (n=8469) coronary artery disease. Ischemia at stress echocardiography was observed in 768 (27%) diabetics and 2644 (23%) nondiabetics. During a median follow-up of 30 months (first quartile, 9; third quartile, 63), 1213 patients died. In diabetics, multivariable indicators of mortality were age (hazard ratio [HR], 1.07, 95% confidence interval [CI], 1.06-1.09), rest wall motion abnormality (HR, 2.43; 95% CI, 1.83-3.22), and ischemia at stress echocardiography (HR, 1.71; 95% CI, 1.34-2.18). In nondiabetics, multivariable indicators of mortality were age (HR, 1.07; 95% CI, 1.06-1.08), rest wall motion abnormality (HR, 2.19; 95% CI, 1.86-2.57), male sex (HR, 1.65; 95% CI, 1.41-1.93), ischemia at stress echocardiography (HR, 1.54; 95% CI, 1.32-1.80), and antischemic therapy at the time of test (HR, 1.15; 95% CI, 1.00-1.32). In stress echo negative subjects for ischemia, antischemic therapy showed increased annual mortality in nondiabetic patients with (3.8% versus 3.1%; P=0.04) or without rest wall motion abnormality (1.6% versus 0.9%; P<0.0001); it failed to do so in diabetic patients with (5.7% versus 5.8%; P=0.89) or without rest wall motion abnormality (2.6% versus 1.9%; P=0.10).
Ischemia at stress echocardiography is a strong and independent predictor of total mortality in diabetic as well as nondiabetic patients. Antischemic therapy markedly affects the negative predictive value of stress echocardiography in nondiabetic patients, whereas it is prognostically neutral in the diabetic population.
比较应激超声心动图结果预测糖尿病和非糖尿病患者总体死亡率的能力。
研究组包括 14140 名患者（2835 名糖尿病患者和 11305 名非糖尿病患者），他们因已知（n=5671）或疑似（n=8469）冠心病而行应激超声心动图检查。在 768 名（27%）糖尿病患者和 2644 名（23%）非糖尿病患者中观察到应激超声心动图检查有缺血。在中位随访 30 个月（第一四分位数，9；第三四分位数，63）期间，有 1213 名患者死亡。在糖尿病患者中，死亡的多变量指标为年龄（风险比[HR]，1.07；95%置信区间[CI]，1.06-1.09）、静息壁运动异常（HR，2.43；95%CI，1.83-3.22）和应激超声心动图检查有缺血（HR，1.71；95%CI，1.34-2.18）。在非糖尿病患者中，死亡的多变量指标为年龄（HR，1.07；95%CI，1.06-1.08）、静息壁运动异常（HR，2.19；95%CI，1.86-2.57）、男性（HR，1.65；95%CI，1.41-1.93）、应激超声心动图检查有缺血（HR，1.54；95%CI，1.32-1.80）和检查时的抗缺血治疗（HR，1.15；95%CI，1.00-1.32）。在应激超声心动图检查无缺血的患者中，抗缺血治疗在非糖尿病患者中显示出更高的年度死亡率（有静息壁运动异常的患者为 3.8%，无静息壁运动异常的患者为 3.1%；P=0.04）；而在糖尿病患者中，抗缺血治疗则不然（有静息壁运动异常的患者为 5.7%，无静息壁运动异常的患者为 5.8%；P=0.89）。
应激超声心动图检查有缺血是糖尿病和非糖尿病患者总死亡率的一个强大且独立的预测因素。抗缺血治疗对非糖尿病患者应激超声心动图检查的阴性预测值有显著影响，而对糖尿病患者则无预后意义。
