Michael Lauer

Publications (2)22.24 Total impact

• Article: Use of stress echocardiography to predict mortality in patients with diabetes and known or suspected coronary artery disease.

  Thomas H Marwick, Colin Case, Stephen Sawada, Charles Vasey, Leanne Short, Michael Lauer
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  ABSTRACT: This study sought to determine whether stress echocardiography using exercise (when feasible) or dobutamine echo could be used to predict mortality in patients with diabetes. Stress echo was performed in 937 patients with diabetes (aged 59 +/- 13 years, 529 men) for symptom evaluation (42%) and follow-up of known coronary artery disease (CAD) (58%). Stress echocardiography using exercise was performed in 333 patients able to exercise maximally, and dobutamine echo using a standard dobutamine stress was used in 604 patients. Patients were followed for < or = 9 years (mean 3.9 +/- 2.3) for all-cause mortality. Normal studies were obtained in 567 (60%) patients; 29% had resting left ventricular (LV) dysfunction, and 25% had ischemia. Abnormalities were confined to one territory in 183 (20%) patients and to multiple territories in 187 (20%) patients. Death (in 275 [29%] patients) was predicted by referral for pharmacologic stress (hazard ratio [HR] 3.94, P < 0.0001), ischemia (1.77, P < 0.0001), age (1.02, P = 0.002), and heart failure (1.54, P = 0.01). The risk of death in patients with a normal scan was 4% per year, and this was associated with age and selection for pharmacologic stress testing. In stepwise models replicating the sequence of clinical evaluation, the predictive power of independent clinical predictors (age, selection for pharmacologic stress, previous infarction, and heart failure; model chi(2) = 104.8) was significantly enhanced by addition of stress echo data (model chi(2) = 122.9). The results of stress echo are independent predictors of death in diabetic patients with known or suspected CAD. Ischemia adds risk that is incremental to clinical risks and LV dysfunction.
  Diabetes Care 06/2002; 25(6):1042-8. · 8.09 Impact Factor
• Article: Prediction of mortality using dobutamine echocardiography

  Thomas H Marwick, Colin Case, Stephen Sawada, Curtis Rimmerman, Patricia Brenneman, Roxanne Kovacs, Leanne Short, Michael Lauer
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  ABSTRACT: OBJECTIVESWe sought to find out whether dobutamine echocardiography (DbE) could provide independent prediction of total and cardiac mortality, incremental to clinical and angiographic variables.BACKGROUNDExisting outcome studies with DbE have examined composite end points, rather than death, over a relatively short follow-up.METHODSClinical and stress data were collected in 3,156 patients (age 63 ± 12 years, 1,801 men) undergoing DbE. Significant stenoses (>50% diameter) were identified in 70% of 1,073 patients undergoing coronary angiography. Total and cardiac mortality were identified over nine years of follow-up (mean 3.8 ± 1.9). Cox models were used to analyze the effect of ischemia and other variables, independent of other determinants of mortality.RESULTSThe dobutamine echocardiogram was abnormal in 1,575 patients (50%). Death occurred in 716 patients (23%), 259 of whom (8%) were thought to have died from cardiac causes. Patients with normal DbE had a total mortality of 8% per year and a cardiac mortality of 1% per year over the first four years of follow-up. Ischemia and the extent of abnormal wall motion were independent predictors of cardiac death, together with age and heart failure. In sequential Cox models, the predictive power of clinical data alone (model chi-square 115) was strengthened by adding the resting left ventricular function (model chi-square 138) and the results of DbE (model chi-square 181). In the subgroup undergoing coronary angiography, the power of the model was increased to a minor degree by the addition of coronary anatomy data.CONCLUSIONSDobutamine echocardiography is an independent predictor of death, incremental to other data. While a normal dobutamine echocardiogram predicts low risk of cardiac death (on the order of 1% per year), this risk increases with the extent of abnormal wall motion at rest and stress.
  Journal of the American College of Cardiology 03/2001; · 14.16 Impact Factor