Stress echocardiogaphy: a useful test for assessing cardiac risk in diabetes

Abstract

Cardiovascular disease is the leading cause of death in patients with diabetes therefore prompt diagnosis and treatment of high risk groups is essential. Dobutamine stress echocardiography is a safe, cheap and reliable method for coronary artery disease diagnosis and provides important long term prognostic information. The diagnostic accuracy and prognostic power of this technique has been validated by a number of studies on patients with and without diabetes. This article discusses the application, interpretation, and accuracy of stress echocardiography both in the general population and in patients with diabetes. The role of advanced imaging modalites such as myocardial contrast agents and tissue Doppler imaging is also explored.

Keywords: cardiovascular risk; diabetes; dobutamine stress echocardiography; ischemia.

Figure 1

The ischemic cascade.

Figure 2

17-segment cardiac model.

Figure 3

Typical regional velocity response to ischemia seen with tissue doppler imaging. In this example the basal lateral wall velocities are analyzed. At peak stress the systolic(s) and diastolic (Em and Am) are reduced. There is also a delayed contraction seen after aortic valve closure (PST).