Asymptomatic Diabetic Patients Research Articles

Angiographic evaluation of coronary artery disease in diabetic patients with and without end-stage kidney disease.

The objective of the present investigation was to compare the coronary angiography results in diabetic patients with and without end-stage kidney disease (ESKD). We included prolonged diabetic patients with ESKD (93 patients) and without ESKD (control group, 126 patients). Angiography of the coronary arteries was performed on all patients. Our results revealed that the ESKD patients tended to have a higher degree of coronary artery stenosis in all parts of LAD (p = 0.001, 0.024, and 0.005), proximal and distal RCA (p = 0.013, and 0.008), and proximal and distal LCX artery (p = 0.001, 0.008) than non-ESKD patients. Furthermore, we found that the ESKD group had higher significant coronary artery stenosis in the LAD artery (60.5% vs. 39.5%, p < 0.001), RCA (60.3% vs. 39.7%, p < 0.001), LCX artery (79.5% vs. 20.5%, p < 0.001), and LMCA (84.6% vs 15.4%, p = 0.002) compared to control group. There was a greater prevalence of multiple vessels coronary artery disease (≥ two) among ESKD patients (29%), compared with the non-ESKD group (16.8%, p < 0.001). Significant coronary artery stenosis was meaningfully higher in asymptomatic diabetic ESKD patients on hemodialysis than non-ESKD diabetic patients. Coronary angiography may be beneficial in diabetic patients with ESKD regardless of whether they have ischemic symptoms with low complication rate through radial access.

Cardiovascular Imaging for Coronary Artery Disease in Patients with Diabetes Mellitus.

In patients with diabetes mellitus, accelerated progression of atherosclerosis can lead to worse clinical outcomes. Determining the best diagnostic strategy to identify patients with increased cardiovascular risk is challenging. Current guidelines recommend using both functional imaging and CT angiography to detect myocardial ischemia and coronary artery disease based on pre-test probability. Functional imaging is suggested for patients with a higher clinical likelihood due to its higher rule-in diagnostic capacity. On the other hand, CT angiography is preferred for patients with lower pre-test probability because of its excellent negative predictive value. The optimal management strategy for asymptomatic diabetic patients remains unclear. In asymptomatic diabetic patients, previous randomized trials have not shown benefits from diagnostic testing over standard care. However, these trials were methodologically inconsistent and lacked clear stratification of cardiovascular risk. In terms of invasive evaluation, a combined invasive functional and anatomic imaging approach for angiographically intermediate coronary stenosis appears to be the best, most effective decision pathway for managing diabetic patients.

The impact of coronary artery calcium score assessment on the management and the outcome of asymptomatic diabetic patients

The impact of coronary artery calcium score assessment on the management and the outcome of asymptomatic diabetic patients

Impact Of Coronary Ct Angiography In Asymptomatic Diabetic Patients - Pilot Study

Impact Of Coronary Ct Angiography In Asymptomatic Diabetic Patients - Pilot Study

Valor pronóstico a 10 años de la angiografía coronaria por TAC en pacientes asintomáticos con diabetes tipo 2

Introduction and objectivesThe United Kingdom Prospective Diabetes Study (UKPDS) risk score has limited value for predicting coronary artery disease (CAD) events. We investigated the additive value of coronary computed tomography angiography (CCTA) on top of the UKPDS risk score in predicting 10-year adverse cardiac events in asymptomatic patients with type 2 diabetes. MethodsWe evaluated 589 asymptomatic diabetic patients without a history of CAD who underwent CCTA. The primary outcome was a composite of cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, and revascularization. We estimated the discrimination and reclassification ability for the prediction models, which included combinations of the UKPDS category, severity of stenosis, and coronary artery calcium score by CCTA. ResultsThe incidence of the primary outcome was 12.4%. During 10 years of follow-up, patients without plaque by CCTA tended to have a low CAD event rate, while those with obstructive CAD tended to have a high event rate, irrespective of the baseline UKPDS risk category. The model that included only the UKPDS category had a Harrell's c-index of 0.658; adding the degree of stenosis to the model significantly increased the c-index by 0.066 (P=.004), while adding coronary artery calcium score increased the c-index by only 0.039 (P=.056). Overall, CCTA information in addition to the UKPDS risk category improved the reclassification rate for predicting the primary outcome. ConclusionsIn asymptomatic patients with type 2 diabetes, CCTA information for CAD provided significant incremental discriminatory power beyond the UKPDS risk score category for predicting 10-year adverse coronary events.

Ten-year prognostic value of coronary CT angiography in asymptomatic patients with type 2 diabetes

Introduction and objectivesThe United Kingdom Prospective Diabetes Study (UKPDS) risk score has limited value for predicting coronary artery disease (CAD) events. We investigated the additive value of coronary computed tomography angiography (CCTA) on top of the UKPDS risk score in predicting 10-year adverse cardiac events in asymptomatic patients with type 2 diabetes. MethodsWe evaluated 589 asymptomatic diabetic patients without a history of CAD who underwent CCTA. The primary outcome was a composite of cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, and revascularization. We estimated the discrimination and reclassification ability for the prediction models, which included combinations of the UKPDS category, severity of stenosis, and coronary artery calcium score by CCTA. ResultsThe incidence of the primary outcome was 12.4%. During 10 years of follow-up, patients without plaque by CCTA tended to have a low CAD event rate, while those with obstructive CAD tended to have a high event rate, irrespective of the baseline UKPDS risk category. The model that included only the UKPDS category had a Harrell's c-index of 0.658; adding the degree of stenosis to the model significantly increased the c-index by 0.066 (P=.004), while adding coronary artery calcium score increased the c-index by only 0.039 (P=.056). Overall, CCTA information in addition to the UKPDS risk category improved the reclassification rate for predicting the primary outcome. ConclusionsIn asymptomatic patients with type 2 diabetes, CCTA information for CAD provided significant incremental discriminatory power beyond the UKPDS risk score category for predicting 10-year adverse coronary events.

Clinical relevance of coronary risk classification and reclassification with coronary artery calcium score in asymptomatic people living with diabetes. An observational study

AimsTo explore (i) in what proportion and direction coronary artery calcium (CAC) score reclassifies coronary risk in asymptomatic diabetic patients at high a priori coronary risk, and (ii) whether screening for asymptomatic myocardial ischemia / coronary stenosis only in patients at very high coronary risk - whether a priori or combined with those reclassified at very high risk according to their CAC score - has good sensitivity to detect these conditions. MethodsWe retrospectively selected 377 asymptomatic primary prevention diabetic patients at high or very high a priori coronary risk according to national guidelines. All had their CAC score measured and underwent stress myocardial scintigraphy to detect myocardial ischemia. Those identified with ischemia then had a coronary angiography to identify coronary stenoses. ResultsOf the selected patients, 242 and 135 patients had a high and very high a priori coronary risk, respectively. After taking into account their CAC score, the former were reclassified into three risk categories: moderate (n = 159, 66%), high (n = 38) and very high (45 patients) risk.Myocardial ischemia was identified in 35 patients and coronary stenoses in 14 of the latter. Had a stress scintigraphy been performed only in the 135 patients at very high risk a priori, 18 patients would have been detected with ischemia (sensitivity 51%), and 9 with coronary stenoses (sensitivity 64%). Had a scintigraphy also been performed on the 45 patients at very high risk after CAC-reclassification, an additional 7 and 5 patients with ischemia and coronary stenoses, respectively, would have been identified. ConclusionFollowing national guidelines, 66% of our population of asymptomatic diabetic persons at high a priori coronary risk were reclassified into the moderate risk category, translating into less stringent goals for risk factor control. Eighteen percent were reclassified into the very high-risk category, leading to 100% detection sensitivity for patients with ischemia and coronary stenoses.

AN INCIDENTAL FINDING OF ASYMPTOMATIC PULMONARY MUCORMYCOSIS IN A PATIENT WITH DIABETES

AN INCIDENTAL FINDING OF ASYMPTOMATIC PULMONARY MUCORMYCOSIS IN A PATIENT WITH DIABETES

Orthostatic Hypotension and its Relationship with HbA1c Levels in Patients with Diabetes Mellitus

Introduction: For the diagnosis of diabetes mellitus, various tests are available such as FBS (Fasting blood sugar), PPBS ( Post Prandial Blood Sugar), Oral Glucose Tolerance Test, Random Plasma Glucose Test, HBA1c, etc, of which HBA1c is considered to be the most standard test. As diabetes mellitus can be asymptomatic initially, it can lead to important complications such as neuropathy, nephropathy, retinopathy, cardiovascular diseases, etc if not detected early. Postural blood pressure measurement which diagnoses orthostatic hypotension is a cheap, easy and useful tool to predict HBA1c level even in asymptomatic diabetic patients. Methods: This is a randomized cross-sectional study of 100 diabetic patients attending Medicine OPD or admitted in our tertiary care hospital of South Gujarat. Pretested proforma was used to collect data after taking informed consent. Investigations including blood pressure measured with a standard Sphygmomanometer at the end of 3 min after standing and HBA1c as mentioned in the proforma was carried out. Final analysis has been done with the help of Open EPI and SPSS software. Results: 33% of patients of our study population were found with abnormal orthostatic hypotension. Our data shows orthostatic hypotension is directly associated with high HbA1c,longer duration of DM, and higher value of BMI. No correlation was found between age and gender. Conclusion: Among diabetic patients, high HbA1c, prolong duration of DM and high BMI were associated with abnormal orthostatic hypotension, which can be alarming sign of complications of diabetes mellitus.

SILENT MYOCARDIAL ISCHEMIA AMONG ASYMPTOMATIC TYPE-2 DIABETIC PATIENTS

Objective: To determine the frequency of silent myocardial ischemia among asymptomatic type-2 diabetes mellitus patients. Methodology: This was a Cross sectional descriptive study conducted, after approval from the institutional ethical and research committee. A total of 90 asymptomatic type-2 diabetic patients were recruited for the present study. After informed written consent participants were subjected to a symptom-limited exercise tolerance test to detect the presence of silent myocardial ischemia. Descriptive statistics were applied to find frequencies and percentages for qualitative variables, and mean and standard deviation was used for quantitative variables. SPSS version22 was used for data analysis. Results: Among 90 type-2 asymptomatic diabetic patients, the frequency of silent myocardial ischemia was 36.7% (n=33). The frequency of silent myocardial ischemia among males and females was 57.6% and 42.4% respectively. Frequency of silent myocardial ischemia was found significantly more among patients with family history of CAD (60.6% vs 39.4%; p=0.029), prolonged duration of diabetes (15.2% vs 22.2% vs 63.6%; p=0.026) and group of patients with older age (9% vs 39.4 vs 51.6%; p=0.034). With respect to hypertension, smoking, obesity, and gender didn’t show statistically significant variation in the occurrence of silent myocardial ischemia. Conclusion: More than one third patients of asymptomatic type-2 diabetes mellitus had silent myocardial ischemia. Those with a family history of CAD, prolonged duration of diabetes, and participants with older age were more at risk of underlying silent myocardial ischemia.

Incremental value of global longitudinal strain to predict stress echocardiography positivity in asymptomatic diabetic patients

French guideline recently added the presence of an “abnormal left ventricle” on transthoracic echocardiography (TTE) to define very high-risk diabetic patients who may benefit from silent coronary artery disease (CAD) screening. We aimed to investigate the incremental value of resting Global Longitudinal Strain (GLS) in predicting stress TTE positivity in asymptomatic patients with diabetes mellitus (DM). Consecutive asymptomatic patients with DM referred for screening for silent CAD by stress TTE (effort of dobutamine) between January 2017 and December 2018 were included ( n = 273). Stress test positivity was defined as stress-induced new or worsening of preexisting left ventricular wall motion abnormalities. Patients with a positive stress test ( n = 28; 10%) were more likely to be smokers (71% vs. 17%), to have known diabetes for more than 10 years, carotid atheroma, diabetic nephropathy, diabetic retinopathy (57.1% vs. 18.0%), moderate or severe aortic or mitral calcifications and a lower GLS (−16.7 ± 2.9 vs. −18.9 ± 2.2%) than those with a negative test (all P ≤ 0.014). On multivariate logistic regression analysis, a DM duration > 10 years, diabetic retinopathy and lower GLS (OR [95% CI] = 0.76 [0.64–0.93] per % decrease) remained independently associated with a positive stress TTE. The Chi 2 of the model was significantly improved by the addition of GLS on top of the baseline clinical variables, repolarization abnormalities and DM related complications (Chi 2 56.9 to 73.8; P < 0.001) ( Table 1 , Fig. 1 ). Screening CAD in asymptomatic patients with DM is challenging and debated. In this context, it is crucial to identify early markers of CAD in this population. Our study shows that GLS is strongly associated with the presence of silent ischemia and could be one of these new parameters to be routinely assessed in this population.

A Comparative Study Analysis of Lower Limb and Upper Limb Conduction Velocity among Asymptomatic Patients of Type 2 Diabetes Mellitus

Objectives: Diabetes Mellitus is worldwide disease and diabetic peripheral neuropathy (DPN) is one of the most prevalent micro-vascular complication seen during the progress of disease. Frequently there is subclinical involvement seen for peripheral nerve functions which is revealed on nerve conduction study. Present study aims to assess nerve conduction velocity changes among asymptomatic patients with type 2 diabetes mellitus. Materials and Methods: Total 60 subjects were included for the study, 30 of them were of type 2 diabetes mellitus on regular treatment with disease duration of less than 5 years and asymptomatic for neuropathy and 30 were controls. All the participants were subjected to nerve conduction studies. Results: Nerve Conduction Velocity (NCV) of sural sensory nerve was found to be significantly decreased in diabetic patients as compared to controls. Conclusion: Sensory NCV was significantly decreased in the sural nerve compared to upper limb sensory nerves which suggests that long nerves are more prone to neuropathic changes even in asymptomatic diabetic patients.

Three-Dimensional Global Left Ventricular Myocardial Strain Reduced in All Directions in Subclinical Diabetic Cardiomyopathy: A Systematic Review and Meta-Analysis.

BackgroundThree‐dimensional (3D) speckle tracking echocardiography can identify subclinical diabetic cardiomyopathy without geometric assumption and loss of speckle from out‐of‐plane motions. There is, however, significant heterogeneity among the previous reports. We performed a systematic review and meta‐analysis to compare 3D strain values between adults with asymptomatic, subclinical diabetes mellitus (ie, patients with diabetes mellitus without known clinical manifestations of cardiac disease) and healthy controls.Methods and ResultsAfter systematic review of 5 databases, 12 valid studies (544 patients with diabetes mellitus and 489 controls) were eligible for meta‐analysis. Pooled means and mean difference (MD) using a random‐effects model for 3D global longitudinal, circumferential, radial, and area strain were calculated. Patients with diabetes mellitus had an overall 2.31 percentage points lower 3D global longitudinal strain than healthy subjects (16.6%, 95% CI, 15.7–17.6 versus 19.0; 95% CI, 18.2–19.7; MD, −2.31, 95% CI, −2.72 to −2.03). Similarly, 3D global circumferential strain (18.9%; 95% CI, 17.5–20.3 versus 20.5; 95% CI, 18.9–22.1; MD, −1.50; 95% CI, −2.09 to −0.91); 3D global radial strain (44.6%; 95% CI, 40.2–49.1 versus 48.2; 95% CI, 44.7–51.8; MD, −3.47; 95% CI, −4.98 to −1.97), and 3D global area strain (30.5%; 95% CI, 29.2–31.8 versus 32.4; 95% CI, 30.5–34.3; MD, −1.76; 95% CI, −2.74 to −0.78) were also lower in patients with diabetes mellitus. Significant heterogeneity was noted between studies for all strain directions (inconsistency factor [I2], 37%–78%). Meta‐regression in subgroup analysis of studies using the most popular vendor found higher prevalence of hypertension as a significant contributor to worse 3D global longitudinal strain. Higher hemoglobulin A1c was the most significant contributor to worse 3D global circumferential strain in patients with diabetes mellitus.ConclusionsThree‐dimensional myocardial strain was reduced in all directions in asymptomatic diabetic patients. Hypertension and hemoglobin A1c were associated with worse 3D global longitudinal strain and 3D global circumferential strain, respectively.RegistrationURL: https://www.crd.york.ac.uk/prospero; unique identifier: CRD42020197825.

Sodium-glucose co-transporter2 expression and inflammatory activity in diabetic atherosclerotic plaques: Effects of sodium-glucose co-transporter2 inhibitor treatment

ObjectiveWe evaluated sodium-glucose co-transporter2 (SGLT2) expression and the effect of SGLT2 inhibitor (SGLT2i) therapies on carotid plaques of asymptomatic diabetic and non-diabetic patients. MethodsPlaques were obtained from 296 non-diabetic patients and 227 patients with type 2 diabetes undergoing carotid endarterectomy. 97 patients with type 2 diabetes were treated with SGLT2 inhibitors for 16 ± 4 months before endarterectomy. After propensity score matching analysis, patients with type 2 diabetes were categorized without (n = 87) and with SGLT2i therapy (n = 87). To investigate SGLT2 expression levels' effects on major adverse endpoints (MACE = stroke, transient ischemic attack, myocardial infarction, and death), we evaluated MACE outcomes at a 2-year follow-up. ResultsCompared to plaques from patients without diabetes, plaques from patients with diabetes had higher SGLT2 expression, inflammation, and oxidative stress, along with lower SIRT6 expression and collagen content. Compared with plaques from patients with diabetes, SGLT2i-treated patients with type 2 diabetes presented increased SIRT6 expression and collagen content and lowered inflammation and ion and oxidative stress, thus indicating a more stable plaque phenotype. These results supported in vitro observations on human aorta endothelial cells (EC) (TeloHAEC-cells). Indeed, EC treated with high glucose (25 mM) in the presence of SGLT2i (100 nM canagliflozin) presented higher SIRT6 expression and decreased mRNA and protein SGLT2 levels, nuclear factor-kappa B (NF-B(NF-κB), and matrix metallopeptidase 9 (MMP-9) expression compared to cells treated only with high glucose. After two years following endarterectomy, a multivariable Cox regression analysis showed significantly higher 2-year overall survival from MACE in patients without diabetes (P < 0.01). Among patient with diabetes, the current SGLT2i users presented a significantly lower rate of MACE through 2 years compared to non-SGLT2i users (P < 0.05). ConclusionsThese findings unveil a critical involvement of the SGLT2/SIRT6 pathway in the inflammatory process of diabetic atherosclerotic lesions and suggest its possible favorable modulation by SGLT2i.

Comparing left ventricular mechanical dyssynchrony between diabetic and non-diabetic patients with normal gated SPECT MPI

The aim of this study was to employ phase analysis to diagnose left ventricular mechanical dyssynchrony (LVMD) in asymptomatic patients with diabetes mellitus type 2 and normal perfusion study which may help prevent diabetic cardiomyopathy. Ninety-three consecutive patients with known type 2 diabetes and 81 age- and gender- matched patients without diabetes who were candidates for SPECT-MPI were considered as the control group. The presence of LVMD as an possible risk factor for cardiomyopathy- was determined using phase analysis for each scan with quantitative gated SPECT (QGS) and corridor4DM (4DM) software. All outcomes such as phase bandwidth (PBW) and phase standard deviation (PSD) were compared between the two groups. A total of 174 patients were included in the study. There were no statistically significant difference regarding demographic factors between the two groups (P > 0.05). PBW showed statistically significant differences (increased in diabetics) between the control and diabetic patients (P < 0.05). Kruskal Wallis analysis revealed that as the duration of diabetes is prolonged, especially more than 15years, the probability of LVMD is increased as well (P = 0.021). Fraction of asymptomatic diabetic patients with normal ejection fraction and gated SPECT MPI-especially those with prolonged diabetes- might have some degrees of LVMD. Phase analysis can detect this which in turn may prevent progress into heart failure.

Sural and medial plantar nerve conduction study in the diagnosis of subclinical diabetic neuropathy

Background and Aim Diabetic peripheral neuropathy is one of the most challenging complications of diabetes mellitus. A large number of patients have subclinical neuropathy at the time of detection of diabetes. Proper detection of subclinical diabetic neuropathy is important to prevent more complications. When the symptoms start, there are not many effective therapeutic treatments. Nerve conduction studies (NCS) are known to be sensitive, reliable, noninvasive, and easy to perform to study diabetic neuropathy. Study of the medial plantar and sural nerves can test the most distal parts of the nerves and can be considered an alternative method for the diagnosis of polyneuropathy in the early stages. The aim of this work is to study the utility of both medial plantar and sural nerve conduction in the early diagnosis of diabetic polyneuropathy. Patients and methods Twenty diabetic asymptomatic patients and 20 healthy volunteers of both sexes were included. Their ages ranged between 26 and 44 years and 24 and 46 years, respectively. NCS of the medial plantar and sural nerves for all the patients and control groups is performed using the antidromic method of stimulation for sural nerve and orthodromic stimulation for the medial plantar nerve. Results There were significant changes in the sensory study of both medial plantar and sural nerves of neurologically asymptomatic diabetic patients compared with the control. Conclusion NCS of both medial plantar and sural nerves aids in the detection of subclinical diabetic polyneuropathy.

Prevalence of Diastolic Dysfunction among Asymptomatic Normotensive Diabetics

LV diastolic dysfunction is one of the earliest signs of myocardial involvement in diabetes and hence,an important component in diabetic cardiomyopathy.It is also an important predictor of heart failure and longterm mortality. Diabetics have a 2.5 fold inceased risk of heart failure.It is suggested that early detection of diastolic dysfunction by echocardiography can lead to institution of early measures for prevention of heart failure.The aim of this study is to find the prevalence of diastolic dysfunction in asymptomatic diabetic patients by echocardiography.

Medium-term prognostic value of angio-TC in type 2 diabetic patients without known cardiopathy

Abstract Funding Acknowledgements Type of funding sources: None. Introdution The use of coronary angiography by cardiac CT for the active search for coronary disease in asymptomatic diabetic patients is not generally indicated. On the other hand, in the case of high-risk patients with a high calcium score, there are results that do show a potential benefit of expanding the study with CT coronary angiography. Purpose The aim was to determine the medium-term prognostic value of computed tomography non-invasive coronary angiography (CT angiography) to predict major cardiac events in type 2 diabetic patients (p) without previous cardiac symptoms Methods Observational and prospective study in diabetic patients without symptoms suggestive of coronary heart disease (CHD), derived from performing a CT in the previous 5 years, for different reasons, not related to acute coronary syndrome. The presence of CHD was analyzed, as well as the incidence for cardiac events during follow-up. Results 402 diabetic patients, mean evolution time of the disease: 6.8 +/- 2.1 years, mean Hb1Ac 8.1 +/- 0.7%. 60% of patients were male. Regarding other cardiovascular risk factors: 66.3% were hypertensive. 58.8% dyslipidemic. 26.3% obese. 27.5% smokers. 32.5% ex-smokers. 36.3% had a family history of CHD. Most frequent indication for CT: CHD screening, with previous inconclusive tests (26.3%), followed by pre-surgery evaluation (25%). Agatston Score 278.3 ± 235.8, Agatston Score&amp;gt; 400 132 (32.8%), significant CHD 174 (43.2%), Vulnerable plaques 84 (20.9%) The average follow-up was 5 years (+/- 1.3); 90 p (22.3%) suffered cardiac events (63 cardiac deaths, 27 non-fatal myocardial infarction). Best correlation with events was observed with the presence of significant coronary disease (ostruction&amp;gt; 50%) compared to the Agatston score and the presence of vulnerable plaques (adjusted c-index of 0.59 versus univariate c-index of 0.42, respectively) The annual event rate for patients with normal coronary arteries was 1.8%, which translated into a 5-year event-free survival period. The highest annual event rate of 22.3% was detected in patients with obstructive 3-vessel CAD Conclusions Non-invasive CT angiography allows, after quantifying plaque severity in diabetic patients, to reclassify patients at high / very high risk Diabetic patients with normal coronary arteries on CT angiography had a 5-year survival period free of major cardiac events.

Prognostic value of myocardial perfusion scintigraphy in asymptomatic patients with diabetes mellitus at high cardiovascular risk: 5-year follow-up of the prospective multicenter BARDOT trial

BackgroundThe Basel Asymptomatic High-Risk Diabetics’ Outcome Trial (BARDOT) demonstrated that asymptomatic diabetic patients with an abnormal myocardial perfusion scintigraphy (MPS) were at increased risk of major adverse cardiovascular events (MACEs) at 2-year follow-up. It remains unclear whether this finding holds true even for a longer follow-up.MethodsFour hundred patients with type 2 diabetes, neither history nor symptoms of coronary artery disease (CAD), were evaluated clinically and with MPS. Patients were followed up for 5 years. Major adverse cardiovascular events (MACEs) were defined as all-cause death, myocardial infarction, or late coronary revascularization.ResultsAt baseline, an abnormal MPS (SSS ≥ 4 or SDS ≥ 2) was found in 87 of 400 patients (22%). MACE within 5 years occurred in 14 patients with abnormal MPS (16.1%) and in 22 with normal scan (1.7%), p = 0.009; 15 deaths were recorded. Patients with completely normal MPS (SSS and SDS = 0) had lower rates of MACEs than patients with abnormal scans (2.5% vs. 7.0%, p = 0.032). Patients with abnormal MPS who had undergone revascularization had a lower mortality rate and a better event-free survival from MI and revascularization than patients with abnormal MPS who had either undergone medical therapy only or could not be revascularized (p = 0.002).ConclusionsMPS may have prognostic value in asymptomatic diabetic patients at high cardiovascular risk over a follow-up period of 5 years. Patients with completely normal MPS have a low event rate and may not need retesting within 5 years. Patients with an abnormal MPS have higher event rates and may benefit from a combined medical and revascularization approach.

English

BACKGROUND Silent ischemia can be predicted with simple, non-invasive and cost-effective technique called electrocardiogram (ECG) in asymptomatic diabetic patients. Risk of morbidity and mortality due to cardiac diseases is high in those with diabetes mellitus. Data on electrocardiogram changes is scarce in India in type-2 diabetic patients without symptoms. Therefore, this study was undertaken to study ECG changes in type-2 diabetic patients without symptoms of heart disease. METHODS Hospital based cross-sectional study was carried out over 18 months among 50 cases of type 2 diabetic patients without cardiovascular disease symptoms. Haematological investigations performed for all patients included lipid profile, fasting blood sugar, and HbA1c. 12-lead electrocardiogram in resting position was carried out, and abnormalities in the recorded electrocardiogram were noted in the study questionnaire. RESULTS Mean age of patients was 53.86 ± 3.34 years. Mean duration of diabetes was 11.27 ± 4.19 years. Majority (44 %) were using oral hypoglycaemic drugs and insulin. Mean values of fasting blood sugar (204.92 ± 22.83) and HbA1c (7.32 ± 0.60 %) were raised. Total cholesterol was 188.4 ± 20.39 mg / dl; high density lipoprotein was 40.24 ± 5.67 mg / dl; low density lipoprotein was 98.64 ± 14.01 and the triglycerides were 182.9 ± 18.44 mg / dl. 28 % had ECG changes and among them the most common was ST depression with T wave inversion in 35.7 % followed by left ventricular hypertrophy (LVH) in 28.6 %. Among variables compared between the two groups, only duration of diabetes (years), and HbA1c (%) were found to be statistically significant (P &lt; 0.05). CONCLUSIONS This study shows that type 2 diabetes patients especially of longer duration should undergo cardiac evaluation even though they do not have any symptoms relating to cardiovascular system. KEYWORDS Diabetes, ECG, Cardiac Changes, Evaluation, Symptoms