P210Study of silent myocardial ischemia in type 2 diabetic males: upper egypt experience

Abstract

Purpose: Accelerated atherosclerosis is one of the most common complications of diabetes mellitus. A crucial aspect of coronary artery disease in this situation is its silent nature. Aim of the work: To detect the prevalence of silent myocardial ischemia (SMI) in type 2 diabetic males in Upper Egypt and to select diabetic males who should be screened for (SMI). Methods: The study includes 100 type 2 diabetic males with negative history of angina and 30 healthy subjects. Blood glucose , lipid profile, (HbA1c), microalbuminurea, and C-reactive protein were done. Non invasive tests (NITs) including ECG, echocardiography, treadmill exercise ECG, myocardial perfusion imaging were done for all participants and patients positive for one or more NITs were subjected for coronary angiography. Results: Twenty nine patients (29%) were positive for one or more NITs compared to only one case (3.3%) in the control group. After the results of coronary angiography, 20 patients were positive for significant coronary artery stenosis in patient group while it was refused to be done in the control group. There were significantly higher levels of microalbuminurea, C-reactive proteinand serum lipids in the patient group. Patient group was subdivided into two subgroups according to the results of coronary angiography, 20 positive for SMI (positive for coronary angiography) and 80 negative for SMI (negative for coronary angiography). Smoking, hypertension, obesity, hyperlipidemia, and family history of IHD were significantly higher in the diabetic subgroup positive for SMI compared to those negative for SMI.Chronic diabetic complications were more prevalent in patients positive for SMI than in those negative for SMI. Most of the patients positive for SMI had have DM for than 5 years duration. Resting ECG and resting Echo detected only 6 and 11 cases, respectively, of the 20 positive cases in group positive for SMI compared to treadmill exercise ECG and myocardial perfusion imaging that detected 16 and 18 cases respectively, Conclusion: Type 2 diabetic male patients should be screened for detection of SMI when age above 50 years, diabetes duration is more than 5 years ,presence of two or more cardiac risk factors and/or patients with one or more of chronic diabetic complications. CRP, is an important parameter for selection of type 2 diabetic male patients who should be screened for SMI. Treadmill exercise ECG and myocardial perfusion imaging are reliable tests for screening of SMI in type 2 diabetic males in our locality.