Abstract
Wackers FJ, Young LH, Inzucchi SE, Chyun DA, Davey JA, Barrett EJ, Taillefer R, Wittlin SD, Heller GV, Filipchuk N, Engel S, Ratner RE, Iskandrian AE, the Detection of Ischemia in Asymptomatic Diabetics (DIAD) Investigators: Detection of silent myocardial ischemia in asymptomatic diabetic subjects. Diabetes Care27 : 1954-1961,2004 [OpenUrl][1][Abstract/FREE Full Text][2] Objective. To determine the prevalence and severity of inducible myocardial ischemia in asymptomatic patients with type 2 diabetes, aged 50-75 years, with normal electrocardiograms (ECGs), using adenosine-stress single photon emission-computed tomography (SPECT) myocardial perfusion imaging along with clinical and laboratory predictors of abnormal test results. Design. A randomized, open, prospective, clinical trial following patients for a period of 5 years to determine the prevalence and predictors of silent myocardial ischemia (SMI) in people with type 2 diabetes with no history of known coronary artery disease (CAD) and no cardiac symptoms. Approximately half of the subjects were randomized to adenosine-stress perfusion imaging at baseline and follow-up, and half were randomized to follow-up without imaging screening. End points. Prevalence, severity, and predictors of patients with SMI as defined by perfusion abnormalities on pharmacological stress perfusion imaging (adenosine-sestamibi SPECT). Results. Of 1,123 patients with type 2 diabetes aged 50-75 years without known or suspected CAD, 113 (22%) had silent ischemia. Eighty-three had regional myocardial perfusion abnormalities, and 30 had normal perfusion with other abnormalities. Moderate and large perfusion defects were present in 33 patients (6% of the screened cohort). Of those with perfusion abnormalities, 96% had some degree of reversibility indicative of ischemia. The strongest predictors … [1]: {openurl}?query=rft.jtitle%253DDiabetes%2BCare%26rft.stitle%253DDiabetes%2BCare%26rft.issn%253D0149-5992%26rft.aulast%253DWackers%26rft.auinit1%253DF.%2BJ.Th.%26rft.volume%253D27%26rft.issue%253D8%26rft.spage%253D1954%26rft.epage%253D1961%26rft.atitle%253DDetection%2Bof%2BSilent%2BMyocardial%2BIschemia%2Bin%2BAsymptomatic%2BDiabetic%2BSubjects%253A%2BThe%2BDIAD%2Bstudy%26rft_id%253Dinfo%253Adoi%252F10.2337%252Fdiacare.27.8.1954%26rft_id%253Dinfo%253Apmid%252F15277423%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=diacare&resid=27/8/1954&atom=%2Fdiaclin%2F23%2F3%2F126.atom
Highlights
Of 1,123 patients with type 2 diabetes aged 50–75 years without known or suspected coronary artery disease (CAD), 113 (22%) had silent ischemia
Cardiac autonomic dysfunction was found to be a strong predictor of abnormal stress tests, suggesting that patients with cardiac autonomic neuropathy deserve close attention
The relationship between abnormal perfusion imaging and cardiac events in asymptomatic patients should be further elucidated at the 5-year follow-up evaluation
Summary
Because of the significant correlation between diabetes and heart disease and the higher likelihood of initial poor outcomes, it would be beneficial to know the true prevalence of CAD in this population and other associated risk factors to stratify patients with diabetes. Several large screening studies for SMI in diabetes have been performed demonstrating variable prevalence rates from 6.4 to 58%.3–5 The higher prevalence estimates are likely the result of both retrospective data in patients with documented angiographic evidence of CAD4 and the inclusion of individuals with abnormal ECGs and those with a high suspicion of CAD.[5] Lower prevalence rates are likely related to the exclusion of patients with microvascular disease or the use of insulin therapy.[3]
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