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Does the Presence of Diabetes Mellitus Make a Difference in Pharmacological Stress Echocardiography Outcome Results?

ABSTRACT: BACKGROUND:Coronary artery disease (CAD) is the leading cause of mortality and morbidity in patients with diabetes (DM). AIM:The aim of our study was to analyse the ability of pharmacological SE to risk stratify patients with DM using qualitative and quantitative assessment of LV function. METHODS:We prospectively assessed 105 consecutive patients (58.7 ± 9.5 y, 39 male) with known or suspected CAD who underwent dipyridamole or dobutamine SE. RESULTS:Change of systolic LV function at maximal SE was less pronounced in patients with DM, while parameters of the diastolic function and its change with stress were almost insignificant. WMSI in comparison to GLS% didn't make a difference in SE outcome regarding DM presence. WMSI was almost unchanged at maximal stress in diabetic patients. Conversely, GLS% showed significant worsening at maximal stress in diabetic patients. However, only WMSI at maximal stress along with DM presence appeared as independent predictors of the presence of new and worsening CAD during SE. Longitudinal strain assessed using speckle tracking during pharmacological stress echocardiography was superior to conventional echocardiography expressed by wall motion analysis in making a difference regarding DM presence. CONCLUSION:We confirmed the usefulness of stress echocardiography using qualitative and/or quantitative parameters in the detection of CAD in patients with DM.

SUBMITTER: Andova V

PROVIDER: S-EPMC6290403 | biostudies-other | 2018 Nov

REPOSITORIES: biostudies-other

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Does the Presence of Diabetes Mellitus Make a Difference in Pharmacological Stress Echocardiography Outcome Results?

Andova Valentina V Georgievska-Ismail Ljubica L Srbinovska Elizabeta E Janeska Biljana B

Open access Macedonian journal of medical sciences 20181120 11

<h4>Background</h4>Coronary artery disease (CAD) is the leading cause of mortality and morbidity in patients with diabetes (DM).<h4>Aim</h4>The aim of our study was to analyse the ability of pharmacological SE to risk stratify patients with DM using qualitative and quantitative assessment of LV function.<h4>Methods</h4>We prospectively assessed 105 consecutive patients (58.7 ± 9.5 y, 39 male) with known or suspected CAD who underwent dipyridamole or dobutamine SE.<h4>Results</h4>Change of systol ...[more]

PMID: 30559865

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Project description:IntroductionThe diagnosis of diabetes mellitus is based on suitable cut-off values of specific biomarkers, such as the concentration of glucose in plasma. The German Diabetes Association has very recently published a clinical practice guideline on the definition, classification and diagnosis of diabetes mellitus that recommends measurements of plasma glucose concentration have an imprecision defined as a minimal difference (MD) of at a fasting plasma glucose concentration of 7.0 mmol/L. To obtain reliable values for the MD, we investigated long-term and short-term measurement uncertainty.MethodsThe imprecision was determined by two approaches: (1) a long-term dataset with imprecision based on the Guideline of the German Medical Association on Quality Assurance in Medical Laboratory Examinations (Rili-BAEK), in a medical laboratory operating 24/7, using internal quality control (IQC) data for four concentrations during a 10-year period; and (2) a detailed short-term dataset with imprecision assessed by hourly measurements of control materials. These datasets were used to calculate the MD cut-off (MDcut-off) as: [Formula: see text] = 2 [Formula: see text], where SD is the standard deviation and k = 2 represents a confidence level of 95%.ResultsThe MDcut-off of ≤ 0.7 mmol/L at a fasting plasma glucose concentration of 7.0 mmol/L (MDcut-off 7.0) for the long-term and the short-term approaches were 0.44 and 0.40 mmol/L, respectively. The MDcut-off 7.0 from both approaches was therefore below the recommended value of 0.7 mmol/L. It was noted that the variability in performance within and between instruments can be covered by reporting the long-term MDcut-off 7.0 across all connected instruments. In this study, stable results for the MDcut-off 7.0 were obtained after 1 year.ConclusionImprecision as measured by IQC data is remarkably stable over many years of operation. Current imprecision assessment usually focuses on only single instruments, whereas clinicians perceive the measurement as the result of the combined analytical performance of all instruments used for a certain assay. In the clinical setting, the MD may be a more useful measure of imprecision, and we suggest deriving the MDcut-off combined from all instruments and control cycles that are used in the patient care setting for a given analyte.

Project description:BackgroundDiabetes-related disparities are well documented among racial minority groups in the United States. Online programs hold great potential for reducing these disparities. However, little is known about how people of different races utilize and communicate in such groups. This type of research is necessary to ensure that online programs respond to the needs of diverse populations.ObjectiveThis exploratory study investigated message frequency and content on bulletin boards by race in the Internet Diabetes Self-Management Program (IDSMP). Two questions were asked: (1) Do participants of different races utilize bulletin boards with different frequency? (2) Do message, content, and communication style differ by race? If so, how?MethodsSubjects were drawn by purposeful sampling from participants in an ongoing study of the effectiveness of the IDSMP. All subjects had completed a 6-week intervention that included the opportunity to use four diabetes-specific bulletin boards. The sample (N = 45) consisted of three groups of 15 participants, each who self-identified as American Indian or Alaskan Native (AI/AN), African American (AA), or Caucasian, and was stratified by gender, age, and education. Utilization was assessed by counting the number of messages per participant and the range of days of participation. Messages were coded blindly for message type, content, and communication style. Data were analyzed using descriptive and nonparametric statistics.ResultsIn assessing board utilization, AAs wrote fewer overall messages (P = .02) and AIs/ANs wrote fewer action planning posts (P = .05) compared with Caucasians. AIs/ANs logged in to the program for a shorter time period than Caucasians (P = .04). For message content, there were no statistical (P <or= .05) differences among groups in message type. No differences were found in message content between AAs and Caucasians, but AIs/ANs differed in content from both other groups. Caucasians wrote more on food behaviors than AIs/ANs (P = .01), and AIs/ANs wrote more about physical activity than Caucasians (P = .05) and about walking than the other two groups (P = .01). There were no differences in communication style.ConclusionsAlthough Caucasians utilized the boards more than the other two groups, there were few differences in message type, content, or style. Since participation in bulletin boards is largely blind to race, age, gender, and other characteristics, it is not clear if finding few differences was due to this optional anonymity or because non-Caucasian participants assumed that they were communicating with Caucasians. If the low variability between racial groups indicates that the IDSMP is flexible enough to meet the needs of multiple racial groups, then online programs may be an accessible and effective tool to reduce health disparities. These questions need to be investigated in future studies.

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Does the Presence of Diabetes Mellitus Make a Difference in Pharmacological Stress Echocardiography Outcome Results?

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Does the Presence of Diabetes Mellitus Make a Difference in Pharmacological Stress Echocardiography Outcome Results?

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