Abstract
AimsEndothelial dysfunction is an early risk marker of cardiovascular disease in diabetes mellitus. Timely screening is important in reducing cardiovascular disease-associated morbidity and mortality. This cross-sectional study investigates the acceptability and preferability of non-invasive cardiovascular risk procedures (EndoPAT2000 system and the ECG-gated fundoscope) in participants with diabetes mellitus compared to controls.MethodsA self-administered Likert scale-based questionnaire was completed by 106 controls and 117 participants with diabetes mellitus, identified through stratified random sampling, upon conclusion of an Australian Heart Eye sub-study conducted at Westmead Hospital, NSW, Australia from 2012 to 2014. Pearson’s χ2 test, independent-samples t-test and regression analysis were performed.ResultsStudy participants who responded to the questionnaire had no preference for procedures (controls: 2.4 ± 1.1 vs diabetes mellitus: 2.5 ± 0.9, p = 0.38) but had an overall more negative experience with most aspects of the ECG-gated fundoscope than the EndoPAT2000 system. Of those with diabetes mellitus, participants who provided poorer self-rated health expressed discomfort with the mydriatic drops (ß 0.27, 95%CI 0.001 - 0.54, p = 0.049) and the fundoscope’s green light filter (ß 0.27, 95%CI 0.07 - 0.47, p = 0.009), as well as maintaining still (ß 0.40, 95%CI 0.08 - 0.72, p = 0.02) and not blinking (ß 0.38, 95%CI 0.07 - 0.70, p = 0.02) during photo acquisition. These participants were also less willing to repeat the ECG-gated fundoscope procedure (ß 0.29, 95%CI 0.07 - 0.52, p = 0.01).ConclusionsParticipants with diabetes mellitus, especially with poorer self-rated health, had a more negative experience with the ECG-gated fundoscope than the EndoPAT2000 system. Difficulties experienced under examination by the ECG-gated fundoscope appear related to the procedural design, which requires amendments improving patient comfort and compliance.
Highlights
In a recent study [3], we demonstrated that the ECG-gated fundoscope had a higher test performance than the EndoPAT2000 system at identifying a greater proportion of
We determined that acquiring digital retinal images at the QRS using an ECG-gated fundoscope improves the accuracy of retinal vessel calibre measurements in controls and diabetes mellitus, by accounting for cardiac cycle-generated pulsatile flow and mechanical part delays [9]
The retina is not subject to autonomic innervation [9] requiring minimal preparation prior to ECG-gated retinal examinations. This is unlike the EndoPAT2000 system that necessitates participants to be fasted and abstain from medications prior to the study [10], which can be difficult in participants with diabetes mellitus
Summary
For effective implementation of screening programmes, the principles of screening devised by the World Health Organization should be considered for all screening procedures [1]. The EndoPAT2000 system and digital retinal imaging are two commonly reported non-invasive procedures that are designed to assess endothelial dysfunction for cardiovascular risk screening in different populations. The EndoPAT2000 system is designed to examine digital reactive hyperaemia following brachial artery occlusion [4] This method is a comparable alternative to flow-mediated dilation [5, 6, 7], which is the most accurate noninvasive method for assessing endothelial function. The retina is not subject to autonomic innervation [9] requiring minimal preparation prior to ECG-gated retinal examinations. This is unlike the EndoPAT2000 system that necessitates participants to be fasted and abstain from medications prior to the study [10], which can be difficult in participants with diabetes mellitus. The ECG-gated device can be inserted into the standard fundoscope [11] and provide additional health information, especially for people with diabetes mellitus who are already frequently screened for diabetes-related pathology
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