Abstract 9467: Prevalence of Chest Pain in Diabetics with Inflammatory Heart Disease

Abstract

Introduction: The deleterious effects of chronic or poorly controlled diabetes mellitus (DM) on the cardiovascular system are well documented, but the prevalence of chest pain associated with inflammatory heart disease (IHD) has not been determined. This study was designed to assess and compare the prevalence of chest pain associated with IHD in diabetic (DM) and non-diabetic (ND) populations. Hypothesis: Diabetic patients may have decreased prevalence of chest pain due to IHD. Methods: A pooled cohort cardiac MRI (CMR) database was queried for all patients who had complete records pertaining to diabetes mellitus, inflammation on CMR, and concurrent chest pain. IHD was defined as myocarditis and/or pericarditis on CMR using using the Modified Lake Louise Criteria published in 2018 using not only T2 STIR and delayed gadolinium imaging, but also T1 and T2 relaxation mapping. Two of these 4 pulse sequences had to be abnormal for a IHD diagnosis. Patients were divided into disease (DM) and control (ND) groups, which were then stratified by IHD-associated chest pain. A two-tailed, two proportion Z-test with a significance value cutoff of p ≤ 0.05 was used for statistical analysis of populations. Results: A total of 951 DM patients and 3134 ND patients were identified. The DM group had 157 patients with CMR-confirmed IHD, of which 94 reported chest pain at 59.87% prevalence. The ND group had 699 patients with IHD, with 495 reporting chest pain at 70.81% prevalence. There was a statistically significant differences between groups related to prevalence of chest pain in cases of confirmed IHD (p<0.0001). There was also a statistically significant difference (p=0.0354) between groups in population prevalence of IHD-associated chest pain in DM (9.88%, 94/951) and ND (14.79%, 494/3134). Conclusions: The ND group demonstrated a 10.94% higher prevalence of chest pain among CMR-confirmed cases of IHD, and a 5.91% higher population prevalence of chest pain associated with IHD. This data suggests that diabetes confers a greater risk of asymptomatic IHD that may go undetected. The lower prevalence of chest pain in DM patients may possibly be explained by diabetic neuropathy induced attenuation of cardiac nociceptive pain response.