Prevalence and prognosis of left ventricular systolic dysfunction in asymptomatic diabetic patients without known coronary artery disease referred for stress single-photon emission computed tomography and assessment of left ventricular function - 16/08/11
, Paul Sorajja, MD a, Navin Rajagopalan, MD a, Todd D. Miller, MD a, David O. Hodge, MS b, Robert L. Frye, MD a, Raymond J. Gibbons, MD aRésumé |
Background |
The prevalence and prognosis of reduced left ventricular ejection fraction (LVEF) in asymptomatic diabetic patients without known coronary artery disease (CAD) are not known.
Methods |
We examined 1046 asymptomatic diabetic patients (age 60 ± 13 years, 69% male) without known CAD referred to a tertiary referral center for stress single-photon emission computed tomography (SPECT) and assessment of LVEF. Patients were stratified according to the presence of normal LVEF (≥50%), mildly reduced LVEF (35%-49%), or moderately/severely reduced LVEF (<35%). Single-photon emission computed tomographic images were classified as low, intermediate, or high risk based on the summed stress score (normal = 56). The mean follow-up was 5.3 ± 3.3 years.
Results |
The prevalence of reduced LVEF was 16.7% (n = 175, mean LVEF 40.0% ± 7.7%). This group was older (63 ± 11 vs 59 ± 14 years, P = .005), had more peripheral arterial disease (45% vs 29%, P < .001), and had a higher prevalence of electrocardiographic Q waves (21% vs 9%, P < .001) than the group without reduced LVEF. Mean summed stress (44.8 ± 9.8 vs 51.7 ± 6.3, P < .001), summed reversibility (4.7 ± 5.0 vs 2.9 ± 4.5, P < .001), and summed rest scores (49.4 ± 7.2 vs 54.6 ± 3.1, P < .001) were significantly more abnormal in the reduced LVEF group. High-risk summed stress score was significantly more common in the reduced LVEF group (46% vs 16%, P < .001). Survival was significantly lower in patients with any reduction in LVEF compared with those without reduced LVEF (10-year survival, 29% vs 57%, P < .0001). By multivariate analysis, reduced LVEF was independently associated with increased mortality (adjusted χ2 = 6.26, P = .01).
Conclusions |
In this population of asymptomatic diabetic patients without known CAD referred for stress SPECT, 1 in 6 patients had reduced LVEF. Most of these patients have intermediate-/high-risk SPECT scans. The annual mortality rates of the groups with and without reduced LVEF were 7% and 4%, respectively.
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| Dr Chareonthaitawee was supported by a research grant from King Pharmaceuticals, Cary, NC; Dr Miller by research grants from Bristol-Myers Squibb, North Billerica, MA, and King Pharmaceuticals); and Dr Gibbons by a research grant from King Pharmaceuticals. |
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| Presented in part at the 54th Annual Scientific Session of the American College of Cardiology, March 6-9, 2005, Orlando, FL. |
Vol 154 - N° 3
P. 567-574 - septembre 2007 Retour au numéro
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