||Sohag Medical Journal
||Omar Saad Mohammad Salem, Lotfy Hamed Abo Dahab, Usama Ahmed Arafa and Ahmed Mohammad Boghdady
Introduction: Cardiovascular diseases are considered the leading cause of death in patients with diabetes in particular, coronary artery disease (CAD) is the cause of death in more than half of these patients. Diabetes is present in as many as 30% of patients hospitalized because of acute coronary syndromes and is associated with greater mortality during the acute phase of myocardial infarction and a higher morbidity in the post infarction period. Dobutamine stress echocardiography is a safe, cheap and reliable method for coronary artery disease diagnosis and viability 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.
Aim of the work:To evaluate the role of the dobutamine stress echocardiography in the evaluation of coronary ischemia before and after coronary revascularization either with PCI (Percutenous Coronary Intervention) or CABG (Coronary Artery Bypass Grafting) in diabetic patients for the detection of the myocardial functional recovery and recurrent ischemia after coronary intervention in Sohag University Hospital.
Patients and Methods: Study design: Prospective single center comparative non randomized clinical study.Patients: During the study period, 150 patients met inclusion criteria for Dobutamine Stress Echocardiography and divided according to the procedure of revascularization into three equal groups (each group involves 50 patients): Group A: Patients treated with CABG, Group B: Patients treated with PCI with DES and Group C: Patients treated with PCI with BMS. Also each group is subdivided into another subgroup according to the presence or absence of DM. Patients in our study, who matched with the selection criteria, were subjected to: 1-History taking and clinical Examination. 2-Laboratory Investigations: Serum glycated HbA1c, Serum creatinine and serum lipogram. 3- 12 lead surface ECG. 4- Baseline Resting Echocardiography. 5-Dobutamine Stress Echocardiography.
Result: Comparing EF between the three groups at baseline (pre-procedure) and after 6 and 12 months post procedure, respectively revealed that EF improved in the three groups. Comparing EF between diabetic and non diabetic patients among the three groups both before procedure, and at 6 and 12 months post procedure showed significant differences in all figures, with diabetics showed always worse EF.Ischemic mitral regurge (IMR) was similar among the three groups at baseline, improved at 6 months and at 12 months; this improvement was highest among CABG, followed by PCI with DES and lastly among PCI with BMS. Comparing Wall motion abnormality (WMA) and Wall Motion Score Index (WMSI) between the three groups at baseline (pre-procedure), and after 6 and 12 months post-procedure, respectively revealed that WMA and WMSI improved in the three groups, but the improvement was higher among cases of the CABG and DES groups compared to BMS groups. Most of cases did not have complications including in addition overall mortality, and this is fixed in the three groups, with no significant difference. Regarding MACE between the three groups, the only significant difference was seen in target lesion revascularization (TLR) at 12 months, with CABG was the best group and BMS was the worst. There was no significant difference between DM and non DM patients in all groups as regards the occurrence of MACE. The only exception was TLR at 12 months, where diabetic patients were significantly worse than non diabetics in all groups. There was no significant difference between DSE positive and negative results in all groups as regards the occurrence of MACE. The only exception was TLR at 12 months, where DSE positive patients were significantly worse in diabetics than non diabetics in all groups.
Conclusion: DSE is essential for the evaluation of coronary ischemia and the impact of different procedures of coronary revascularization in diabetic patients for the assessment of cardiac function and relations of the different parameters of the test to the follow up of improvement of the function and occurrence of MACE.