Prevalence Of Silent Myocardial Ischemia Research Articles

Assessing the Impact of Chronic Obstructive Pulmonary Disease on Severity of Silent Myocardial Ischemia in Patients with Arterial Hypertension

The objective: to evaluate the effect of chronic obstructive pulmonary disease on the severity of silent myocardial ischemia in patients with arterial hypertension.Subjects and Methods. Examinations and follow-up of 194 COPD patients who were undergoing outpatient follow-up and treatment were analyzed. Those patients suffered from COPD with concurrent arterial hypertension or isolated arterial hypertension.Results. Holter ECG monitoring should be done in all COPD patients regardless of severity of the disease and presence of comorbid conditions. This is due to the high prevalence of silent myocardial ischemia in such patients.

FACTORS ASSOCIATED WITH SILENT ISCHEMIA IN TYPE 2 DIABETIC PATIENTS

Objective: The present study was conducted to study the role of treadmill testing (TMT) in identifying silent ischemia in diabetic patients and to assess factors associated with silent ischemia in them. Methods: The study was a hospital-based cross-sectional study where 60 patients with type 2 diabetes between the age 40 and 60 years without an established clinical diagnosis of coronary artery disease attending medical OPD were included in the study. The TMT was done using a computerized CTMT machine with built-in protocols. Continuous electrocardiogram (ECG) recordings were taken. Results: The prevalence of silent myocardial ischemia in type 2 asymptomatic diabetes mellitus in this study was found to be 28.3%. Smoking, higher age, alcohol intake, and duration of DM were found to be significantly associated with silent myocardial ischemia. Conclusion: Thus, we conclude that the prevalence of silent myocardial ischemia is more common in diabetics. Early screening of asymptomatic patients with type 2 diabetes mellitus with the help of TMT for evidence of silent myocardial ischemia may prevent catastrophic cardiac events.

SILENT MYOCARDIAL ISCHEMIA IN PATIENTS WITH ACUTE CORONARY SYNDROME AND DIABETES MELLITUS

ST-segment elevation myocardial infarction, stenting of the infarct-related coronary artery, silent (painless) myocardial ischemia, diabetes mellitus, 24-hour electrocardiographic monitoring.
 Introduction. Currently, approximately 422 million people in the world have diabetes mellitus, and over 1.3 million individuals in Ukraine are diagnosed with diabetes mellitus. Diabetic neuropathy is known to contribute to the development of atypical and painless variants of ischemic heart disease in individuals with diabetes. This poses a challenge for timely diagnosis and obscures the course of ischemic heart disease, as the prevalence of silent myocardial ischemia is significantly high in these patients. Therefore, the aim of this study is to investigate the occurrence of myocardial ischemia episodes in patients with ST-elevation myocardial infarction within the first day following stenting of the infarct-related coronary artery. Furthermore, we aimed to demonstrate the painless nature of these episodes in the presence of type 2 diabetes mellitus through a clinical case presentation.
 Materials and methods. 30 patients with ST-segment elevation myocardial infarction were examined, and 24-hour electrocardiographic monitoring was performed during the first day after the infarct-related coronary artery stenting. Results. Episodes of transient myocardial ischemia were registered in 50% of people. We found that the majority of episodes (80%) were painless. In the presence of diabetes mellitus, only episodes of painless myocardial ischemia were noted that is supported by the example of a clinical case. The study highlighted the informativeness of 24-hour electrocardiographic monitoring in identifying episodes of myocardial ischemia, particularly in its painless variant. The results demonstrate that patients with ST-elevation myocardial infarction (STEMI) experience episodes of transient myocardial ischemia within the first day after coronary artery stenting, with a majority of these episodes being painless. Furthermore, in the presence of diabetes mellitus, ischemic episodes tend to be painless. Therefore, 24-hour electrocardiographic monitoring serves as a valuable method for the detection of myocardial ischemia.

Prevalence and determinants of silent myocardial ischemia in patients with type 2 diabetes in Cameroon: a cross-sectional study.

Introductiondiabetes mellitus is a major health problem worldwide. It is associated with high cardiovascular morbi-mortality especially coronary artery disease. Myocardial ischemia is often asymptomatic (silent myocardial ischemia) in people with type 2 diabetes mellitus thus making early diagnosis difficult. Silent myocardial ischemia is defined as the objective evidence of myocardial ischemia in the absence of chest discomfort or other angina equivalents. This study aimed to determine the prevalence and determinants of silent myocardial ischemia in a population of people with type 2 diabetes using exercise stress electrocardiography.Methodswe carried out a cross-sectional study between January and April 2019 at the National Obesity Centre of the Yaounde Central Hospital. Patients with type 2 diabetes underwent a complete clinical evaluation, blood test, resting electrocardiogram (ECG), and exercise stress ECG according to the Bruce protocol. A positive stress test was defined as horizontal or down-sloping ST depression ≥ 1mm or upsloping ST depression of 2 mm or more 0.06 to 0.08 seconds after the J point.Resultsa total of 112 patients with diabetes (63 males and 49 females) were screened. The median age was 58 (IQR: 51 - 64) years. The median time from diabetes diagnosis was 8 (IQR: 5 - 12) years. Fifty-seven (50.4%) had hypertension, 78 (69.0%) had dyslipidemia, 66 (58.4%) were obese, 70 (61.9%) had poor glycemic control, and 23 (20.2%) were smokers. Sixty-five (58%) patients had a positive exercise stress ECG test. Factors independently associated with a positive stress test were abdominal obesity (aOR: 4.2, [95% CI: 1.4 - 12.8]) and Female sex (aOR: 2.5, [95% CI: 1.1 - 5.7]).Conclusionthe prevalence of silent myocardial ischemia was high in a population of asymptomatic patients. This was independently associated with abdominal obesity and female sex.

Assessing the prevalence and predicting factors of an abnormal gated myocardial perfusion SPECT in asymptomatic patients with type 2 diabetes.

Considering the significant prevalence of silent myocardial ischemia and its related morbidity and mortality in asymptomatic type 2 diabetic patients, it is not well known whether early screening with MPI is cost-effective and predicting factors are not well elucidated. This was a cross-sectional study including 63 asymptomatic patients with type 2 diabetes mellitus (T2DM), with normal ECG and ejection fraction. Patients with any history of documented valvular, congestive or ischemic heart disease, renal or hepatic failure were excluded. At first all patients were interviewed and checked for risk factors and then patients underwent a two-day rest/stress 99mTc-MIBI gated MPI SPECT. Data was assessed by QPS/QGS and 4DM software and evaluated by a nuclear medicine specialist with summed stress score (SSS) of more than 4 defined as CAD. There were 42 females (67%) and 21 males (33%), with a mean age of 61.33 ± 6.98years and 7.97 ± 4.86years history of T2DM. CAD was detected in 26 (41.3%) patients and was significantly associated with male gender, smoking and requiring insulin therapy (P-value = 0.019, 0.046, 0.05, respectively). A significant association was found between the duration of diabetes, especially when > 15years, and the probability of having CAD. Multivariable logistic regression revealed that smoking; male gender and diabetes duration were the strongest independent predictors of abnormal MPI results. We found a high (46%) prevalence of abnormal stress MPI SPECT in patients with type 2 diabetes mellitus, despite being asymptomatic. Asymptomatic patients with a history of smoking, long duration of diabetes, being under insulin treatment and male gender might benefit from MPI for early detection of silent ischemia.

Prevalence of unrecognized or "silent" myocardial ischemia in chronic kidney disease patients: Protocol for a systematic review and meta-analysis.

IntroductionChronic kidney disease (CKD) patients are at an extremely high risk of silent myocardial ischemia (SMI). However, there is a dearth of evidence on the worldwide prevalence of this very lethal and yet unrecognizable complication of CKD. The proposed systematic review and meta-analysis aims to estimate the global prevalence of SMI among CKD patients.Methods and analysesThis protocol was conceived according to the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) statement. The systematic review will involve all observational studies and clinical trials published until April 30, 2021, and reporting on the prevalence of SMI in CKD patients. Electronic sources including MEDLINE, Embase, Web of Science, and Cochrane database of systematic reviews will be perused for potentially eligible studies, restricted to only studies published in English or French. Two investigators will independently select studies and use a pre-pilot tested form to extract data. Further, they will independently perform a qualitative assessment of the risk of bias and overall quality of the selected studies, followed by a quantitative assessment using funnel plots and Egger’s tests. The heterogeneity between studies will be assessed with the Cochrane’s Q statistic, and the I2 statistic will measure the percentage of variation across studies that is due to their heterogeneity rather than chance; the I2 will decide if a meta-analysis can be conducted. In case it cannot be conducted, a descriptive analysis will be performed. Otherwise, study-specific estimates will be pooled using either a fixed-effects or a random-effects model, depending on the value of the I2 statistic. Subgroup and random effects meta-regression analyses will further investigate the potential sources of heterogeneity. Finally, sensitivity analyses will be performed to measure the impact of low-quality studies on the results of the meta-analysis, and power calculations will determine the probability that we will detect a true effect if it does exist.PROSPERO registration number CRD42020211929 Strengths and limitations of this studyThe intended systematic review and meta-analysis will fill the knowledge gap on the global prevalence of silent myocardial ischemia (SMI) in CKD patients. The eligible studies will be identified through a methodic literature search followed by a rigorous screening process; we will then use robust meta-analysis tools to pool the data and provide reliable estimates of the global prevalence of SMI in CKD patients. Two major limitations could be: the predominance of clinical trials that might limit the generalizability of the findings, given that some informative patients might have been sidelined by the strict inclusion criteria of these studies; the high probability of type 1 error originating from the important number of subgroup and sensitivity analyses.

Silent myocardial ischemia in patients with type 2 diabetes mellitus: a clinical case

Background. Type 2 diabetes mellitus (DM) is an important medical, social, and economic problem due to the high prevalence of the disease, which often leads to disability and significantly increases mortality in elderly people. One of the causes of coronary heart disease (CHD) in patients with type 2 DM is autonomic cardiovascular neuropathy, which is characterized by damage to the autonomic nervous system and manifests itself in a varying clinical picture, including silent myocardial ischemia (SMI). The prevalence of SMI among patients with type 2 DM is much higher than in people without it. The purpose was to study the clinical case of a patient with type 2 DM and CHD, raise awareness of the prevalence and influence of type 2 DM on CHD progression by focusing on diagnostic research and treatment strategies. Materials and methods. The clinical case of the detected silent ischemia in a patient with type 2 DM was analyzed. The complaints were as following: high blood pressure, moderate shortness of breath during walking, pain, and numbness of the lower extremities. Anamnesis: type 2 DM over 20 years; endovascular stenting of the right common iliac artery due to obliterating atherosclerosis of the arteries of the lower extremities; hypertension over 10 years; obesity. Based on this data, CHD was suspected. Results. The Holter monitoring revealed rare episodes of reversible ischemic repolarization. ECG demonstrated the deviation of the electrical axis to the left, hypertrophy of the left ventricular myocardium, diffuse violation of repolarization processes. Ultrasound of the heart found aortic atherosclerosis, left ventricular myocardial hypertrophy, a moderate decrease in myocardial contractility. Ultrasound of vessels of the lower extremities showed the signs of obliterating atherosclerosis with decompensation of peripheral blood flow. Coronary angiography demonstrated left coronary artery with critical subocclusions (90 %), right coronary artery with chronic occlusion in the middle segment (100 %). There was established the diagnosis: coronary heart disease (silent ischemia); diffuse stenotic atherosclerosis of the coronary artery (coronary angiography May 2019); arterial hypertension II stage, degree 2; HF II stage; II NYHA; type 2 diabetes mellitus, insulin-dependent, decompensated; obesity I stage; obliterating atherosclerosis of the arteries of the lower extremities (condition after endovascular stenting of the right common iliac artery on January 2018); chronic pancreatitis in remission, peptic ulcer of the duodenum (operated in 1981); chronic cholecystitis in remission. The treatment was prescribed: insulin therapy, nebivolol, eplerenone, candesartan, clopidogrel, rosuvastatin. Coronary artery bypass grafting is recommended. Conclusions. Thereby, timely diagnosis and adequate treatment can avoid complications of type 2 DM and improve quality and lifetime. With type 2 DM, CHD is often masked and remains undiagnosed, leading to complications and death, therefore more attention to such patients is needed.

Silent Myocardial Ischemia in Type 2 Diabetic Patients Asymptomatic For Coronary Artery Disease: A Cross- Sectional Study

Background Coronary Artery Disease (CAD) is a common cause of premature morbidity and mortality in diabetics and is often asymptomatic because of silent myocardial ischemia (SMI). Early detection of SMI may prevent catastrophic cardiac events. Objective To study the prevalence of SMI in patients of type 2 diabetes mellitus (Type 2 DM), asymptomatic for CAD and to assess the role of conventional CAD risk factors in diabetic patients asymptomatic for CAD in the development of SMI. Methodology 102 cases of Type 2 DM without any clinical and electrocardiographic evidence of CAD, who attended a tertiary care hospital in North Delhi, over a period of one year, were studied for the present cross-sectional study. Detailed history, general physical examination, BMI, systemic examination and investigations like glycosylated hemoglobin (HbA1c), lipid profile, resting 12-leads electrocardiography (ECG) and treadmill test (TMT) were carried out. Results Out of 102 patients, TMT was found positive in 23 patients. It was positive in 12% among diabetic patients with duration of diabetes ≤5 years, 14.8% in patients with duration 6-10 years, 37.5% in patients with duration 10-15 years and 77.7% in patients with duration 16-20 years, respectively with p<0.001. Conclusion The prevalence of SMI in asymptomatic Type 2 DM without history of CAD is 22.54%. Duration of diabetes, presence of autonomic neuropathy (AN), dyslipidemia and HbA1c level are strong clinical predictors of SMI in asymptomatic Type 2 DM. Keywords: Silent myocardial ischemia; Type 2 Diabetes mellitus; Coronary artery Disease; Treadmill test Asymptomatic; Autonomic Neuropathy.

Silent myocardial ischemia prevalence among a diabetic population at high cardiovascular risk in western Algeria

Silent myocardial ischemia (SMI) is an important cause of morbidity and mortality. Its screening is of a capital importance for its management. The objective of our study was to determine the prevalence of SMI in diabetic patients with high cardiovascular risk as well as the predictive factors. We recruited 216 diabetic patients with high cardiovascular risk defined according to the recommendations of ALFEDIAM/SFC 2004, in whom we searched for a SMI type 1, using an exercise electrocardiogram. The study was performed in Sidi Bel Abbès cardiology university hospital service. The mean age of the population was 59.47 ± 8.25 years and the sex ratio of 1.48. The prevalence of SMI in both genders was 17.6% without significant difference. Criteria for a highly positive SMI was found in 34.2% of them with a higher frequency in men ( P < 0.05). In univariate analysis, age, septal hypertrophy, indexed left ventricular mass, left atrial index volume, micro-albuminuria and pulsed pressure had a significant relationship with the presence of SMI. In multivariate analysis, history of peptic ulcer, elevated serum creatinine, left ventricular hypertrophy (LVH), and carotid stenosis were statistically significant predictors of SMI ( P < 0.05). Highly positive SMI was more common for men. Some predictive markers of the disease were determined, including left ventricular hypertrophy, carotid stenosis, a clinical history of peptic ulcer and an increase in serum creatinine.

CAC: An Under-Utilized Tool for Screening of ASCVD in Diabetes

Diabetes Mellitus is the silent killer of the 21st century affecting 425 million people all over the world. The situation is worse in south east Asia particularly India where the prevalence is increasing at a rapid pace. The overall prevalence of diabetes in all 15 states of India was 7.3%. Coronary artery disease (CAD) contributes the highest in morbidity, mortality and financial burden of diabetes. Observational studies and RCTs report the prevalence of silent myocardial ischaemia in asymptomatic DM as 22%. There are many ways to estimate cardiovascular risk in asymptomatic diabetes people like clinical risk score, various biomarkers and other modalities like exercise stress test, echocardiography, Ankle Brachial Index (ABI), Carotid Intima Media Thickness (CIMT), Coronary Artery Calcium Score (CAC), CT angiography, Cardiac MRI, Nuclear Imaging etc. In this article we tried to review various modalities and their usefulness in screening asymptomatic ASCVD. Out of all available modalities CAC score is found to be very cost effectiveness and sensitive way to predict ASCVD. Still CAC is an underutilized modality to screen asymptomatic ASCVD in diabetes people.

P979 Subclinical left ventricular dysfunction and silent myocardial ischemia in asymptomatic middle-aged patients with type 2 diabetes mellitus

Abstract Early detection of silent myocardial ischemia (SMI) in asymptomatic middle-aged patients (pts) with type 2 diabetes mellitus (T2DM) may be important due to the generally poor prognosis and early myocardial involvement in this specific subgroup of diabetic population. Our goal was to evaluate whether subclinical left ventricular (LV) systolic dysfunction assessed by two-dimensional speckle-tracking echocardiography (2D-STE) is independently related to SMI detected by MPI (gated SPECT myocardial scintigraphy) and if it could provide incremental information over baseline characteristics to identify it. We have tested the hypothesis that the myocardial mechanics significantly differ in asymptomatic middle-aged diabetics, depending on the presence or absence of SMI. In total, 60 consecutive middle-aged (&amp;lt;60 years; 42 males, 70.0%) asymptomatic T2DM pts were enrolled into the study. MPI was performed in one-day protocol according to the EANM procedural guidelines, and SMI was diagnosed consensually by two experts as myocardial perfusion abnormalities without associated symptoms. The T2DM pts were subdivided into two groups according to the results of MPI, namely SMI group (n = 11) and non-SMI group (n= 49) Global longitudinal peak systolic strain (GLPSS) was measured from two- and four-chamber views cines using Automated Function Imaging (Vivid S6, GE). Subclinical LV dysfunction was defined as GLPSS of &amp;gt; -20%. Prevalence of SMI in T2DM pts was 18,3%. All pts in SMI group (n = 11) were of male gender, and disease duration ≥ 5 years. Pooled data from 2D-STE showed significant reduction in mean absolute GLPSS values (p&amp;lt;.001). Further more, pts in SMI group had more impaired GLPSS when compared with patients in non-SMI group (-16.1 ± 1.5% vs. -20.4 ± 1.8%, P &amp;lt; .01). At multivariate analysis, male gender, an amount of epicardial adipose tissue and erectile dysfunction in men were independently associated with SMI. The addition of the LV GLPSS values to other selected independent clinical variables significantly improved the ability to predict SMI in these patients (χ(2) = 48.62; P = .001). Asymptomatic middle-aged T2DM pts with SMI showed a more impaired LV GLPSS compared with patients without silent ischemia. The presence of subclinical LV systolic dysfunction provides significant incremental value for the identification of SMI in asymptomatic middle-aged diabetics.

Prevalence and RIsk factors for Silent Myocardial ischemia (PRISM): A clinico observational study in patients of type 2 diabetes

ObjectivesTo estimate the prevalence and to identify potential risk factors of silent myocardial ischemia in a cohort of patients with asymptomatic type 2 Diabetes (diabetes) for early detection of coronary risk by employing objective noninvasive clinical screening tools for Subclinical Atherosclerosis. MethodsThe study is a clinic-based observational study on 338 consecutive diabetes patients attending an urban health center from Eastern India. The response rate was 96.57% out of 350 eligible subjects, comprising 176 (52.1%) males and 162 (47.9%) females. Clinical, anthropometric, biochemical parameters were collected in all participants. Both tools, i.e., treadmill test (TMT) to identify subjects with silent myocardial ischemia, and carotid imaging to detect subclinical atherosclerosis by evaluating carotid intima-media thickness (CIMT), were assessed. Significant determinants were predicted by multivariable logistic regression. ResultsThe study group was divided into a TMT negative (n = 260), and a TMT positive group (n = 78). These 78 TMT positive subjects (23.1%) were identified to have silent myocardial ischemia. The prevalence of silent myocardial ischemia was more common in males (28.4%) than in females (17.3%). The mean CIMT in our study group was 0.6741 ± 0.034 mm (males – 0.684 ± 0.034 mm and females – 0.663 ± 0.032 mm). Age ≥50 years, CIMT ≥0.70 mm, hypercholesterolemia, and hypertriglyceridemia were significant determinants for identifying asymptomatic diabetics at risk for silent myocardial ischemia. ConclusionSilent myocardial ischemia is highly prevalent at about one in four asymptomatic diabetic patients. An increased CIMT can be a surrogate marker of higher coronary risk amongst these asymptomatic diabetics.

Silent Myocardial Perfusion Abnormalities Detected by Stress Cardiovascular Magnetic Resonance in Antiphospholipid Syndrome: A Case-Control Study.

Objective: To examine the prevalence of silent myocardial ischemia and fibrosis in antiphospholipid syndrome (APS), using stress cardiovascular magnetic resonance (CMR). Methods: Forty-four consecutive APS patients without prior cardiac disease (22 primary APS, 22 systemic lupus erythematosus (SLE)/APS, mean age 44 (12.9) years, 64% women) and 44 age/gender-matched controls were evaluated using CMR at 1.5 T. Steady-state free precession imaging for function assessment and adenosine stress-CMR for perfusion-fibrosis evaluation were employed. The myocardial perfusion reserve index (MPRI), and myocardial fibrosis expressed as late gadolinium enhancement (LGE), were evaluated. Coronary angiography was indicated in patients with LGE. Associations with APS characteristics, classic cardiovascular disease (CVD) risk factors, high-sensitivity CRP (hs-CRP) and high-sensitivity Troponin (hs-TnT) levels were tested. All patients were followed up for 12 months. Results: Median MPRI was significantly lower in APS patients versus controls [1.5 (0.9–1.9) vs. 2.7 (2.2–3.2), p < 0.001], independently of any LGE presence. LGE was detected in 16 (36.3%) patients versus none of controls (p < 0.001); 12/16 were subsequently examined with coronary angiography and only two of them had coronary artery lesions. In multivariable analysis, none of the APS-related and classic CVD risk factors, or hs-CRP and hs-TnT covariates, were significant predictors of abnormal MPRI or LGE. At the twelve month follow-up, three (6.8%) patients experienced coronary artery disease, notably those with the lowest MPRI values. Conclusions: Abnormal MPRI and LGE are common in asymptomatic APS patients, independently so of any APS-related and classic CVD risk factors, or coronary angiography findings in cases with LGE. Stress-CMR is a valuable tool to detect silent myocardial ischemia and fibrosis in APS.

Risk of silent myocardial ischemia detected by single photon emission computed tomography (SPECT) among asymptomatic Chinese patients with type 2 diabetes.

To explore the prevalence and risk factors of silent myocardial ischemia (SMI) detected by using single photon emission computed tomography (SPECT) in Chinese asymptomatic patients with type 2 diabetes (T2D).In this hospital-based retrospective study, 821 T2D patients who were screened for SMI detected by stress myocardial perfusion imaging using SPECT between June 2014 and July 2016 were investigated. Clinical indicators were compared between the patients with SMI and controls without SMI. Risk factors for SMI were evaluated by univariate and multivariate analysis.In this study, there were 131 patients with SMI in asymptomatic diabetes and the prevalence of SMI was 21.3% of 614 individuals. Logistic regression analysis indicated that diabetic retinopathy (OR = 1.474, 95%CI: 1.113–1.951, P = .007), male gender (OR = 1.805, 95%CI: 1.183–2.747, P = .006), and low-density lipoprotein (LDL) cholesterol (OR = 1.298, 95%CI: 1.042–1.615, P = .02) were risk factors associated with SMI. Besides, the prevalence of SMI increased in associated with the progression of retinopathy (P = .041). The percentage of SMI diagnosed in patients with no diabetic retinopathy (NDR), non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR) were 18.5% (75/405), 25.2% (37/147), and 30.6% (19/62), respectively. The percentage of SMI in male (24.5%, 85/347) was higher than that in female (17.2%, 46/267), P = .029.Physicians should be aware of these conditions when examining male patients with type 2 diabetes, especially with DR and/or high level of low-density lipoprotein cholesterol (LDL cholesterol), even if otherwise asymptomatic. A routine screening for SMI may thus be considered advisable in these patients.

Relationship Between Cardiac Autonomic Neuropathy and Atherosclerosis in Patients with Diabetes Mellitus

Cardiovascular disease is the major cause of death in diabetic patients. Diabetes mellitus patients have a 4-fold-higher risk of having a cardiovascular event than people without diabetes. Cardiac autonomic neuropathy is a frequent and severe complication of diabetes mellitus. Definite cardiac autonomic neuropathy is present in one fifth of diabetic patients. Cardiac autonomic neuropathy diagnosis is associated with a 5-fold increase in mortality, higher prevalence of silent myocardial ischemia as well as systolic and diastolic left ventricular dysfunction.

7. Prevalence of CAD in asymptomatic type II diabetics, using MPI as screening tool. Single center cross sectional study from KSA

Clinical research. Oral presentation. In patients with type 2 diabetes coronary artery disease (CAD) is a major cause of mortality and morbidity. Knowing the elevated risk of cardiovascular events and high prevalence of silent myocardial ischemia, screening asymptomatic diabetic patients-yet controversial-is appealing. The aim of the study is to measure the prevalence of silent ischemia in asymptomatic type-II diabetic patient with at least one or more of the given risk factors i.e. Hypertension, Dyslipidemia, Smoking, obesity and F/H of CAD. Myocardial perfusion Imaging is a sensitive test to look for myocardial ischemia. This is a single center cross sectional study, approved by the institutional review board of the hospital. The study subjects were type-II diabetes of >5 years duration, asymptomatic, having one or more of the risk factors; The subjects were screened for CAD using myocardial perfusion imaging (MPI). Further intervention or treatment was left to primary physician in case of positive results. A total of 137 patients-after obtaining an informed consent-underwent MPI. There were no complications during the tests. All of the patients tolerated the test well. ECGs were obtained. Two independent reviewers (blinded to each other’s findings) reviewed tests. A test was considered ”Positive” only if both reviewers results matched (in distribution, severity and size). Of 137 cohort, 21(15%) showed perfusion defects consistent with significant myocardial ischemia in a specific coronary artery distribution. Average sum stress score (SSS) was 5 (range 4–8, mode 4). Of the whole group, patients with higher HbA1C had the positive MPI. Results of positive patients were relayed to their primary physicians. Despite higher rate of diabetes in Saudi Arabia, asymptomatic Diabetics have a lower than expected incidence of active CAD. There would be a need to test this notion further. This would require more studies to confirm our findings in Saudi population.

Evolution of silent myocardial ischaemia prevalence and cardiovascular disease risk factor management in Type 2 diabetes over a 10‐year period: an observational study

To assess the evolution of silent myocardial ischaemia prevalence and of cardiovascular disease risk factor management over 10 years in people with Type 2 diabetes. This repeated cross-sectional study prospectively included 770 people with Type 2 diabetes who presented at our centre in the period 1999-2009. All had at least one additional cardiovascular disease risk factor, no history of coronary disease and were screened for silent myocardial ischaemia using myocardial perfusion imaging. The prevalence of silent myocardial ischaemia, clinical and biological variables and treatments were collected and compared among participants screened in three periods: 1999 to 2002; 2003 to 2005; and 2006 to 2009. We also identified predictive factors for silent myocardial ischaemia. Participants had a mean ± sd age of 62.3 ± 9.3 years, 57.4% were men and the mean time from diagnosis of diabetes was 13.4 ± 9.3 years. Overall, silent myocardial ischaemia screening was positive in 13.9% of participants. This prevalence decreased sharply over the 10-year study period (22.6% in 1999-2002, 13.7% in 2003-2005 and 5.9% in 2006-2009; P<0.0001). In parallel, diastolic and systolic blood pressure, HbA1c and LDL cholesterol significantly decreased and glitazone and statin use increased (all P<0.001). Male gender, peripheral artery disease, diastolic blood pressure >80 mmHg and LDL cholesterol >2.6 mmol/l were independently associated with silent myocardial ischaemia. Further adjustment showed the screening period had a significant effect, which erased the effects of diastolic blood pressure and LDL cholesterol. The prevalence of silent myocardial ischaemia decreased sharply over time, and control of the main cardiovascular disease risk factors improved. Although the causality link cannot be established, the present study supports current recommendations advocating glycaemic control and intensive management of cardiovascular factors instead of systematic screening.

The result of treadmill test in asymptomatic type 2 diabetes mellitus

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;To study the prevalence of silent myocardial ischaemia in asymptomatic patients with type 2 DM&lt;/span&gt;.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;The present study was conducted in the Govt. Medical College and Hospital Aurangabad. During December 2012 to November 2014 with 50 patients. It was two year cross sectional study with the patients of asymptomatic type 2 diabetes mellitus without clinical and electrocardiographic evidence of coronary artery disease. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;12 (24%) out of 50 subjects had positive TMT. It correlated with years of duration of diabetes (9 positive TMT cases with duration of diabetes more than 10 years). 5 (25%) out of 20 had serum cholesterol levels &amp;gt;240, Number of positive TMT were higher in patients with LDL &amp;gt;160 [5 (25%) out of 20]&lt;/span&gt;.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Diabetic patients are at very high risk for cardiovascular morbidity and mortality. Early detection of IHD is very important so that pharmacological therapy, which may improve outcome, can be established. Tread mill exercise TMT being a non-invasive test with high safety, has an important role in early detection of IHD. It is recommended that TMT should be a part of routine management in asymptomatic patients with type II DM. &lt;/span&gt;&lt;/p&gt;

Prevalence of silent myocardial ischemia in type 2 diabetes mellitus with microalbuminuria

Background: The study was designed to assess the prevalence of silent myocardial ischemia (SMI) in asymptomatic patients of type 2 diabetes mellitus (T2DM) with and without microalbuminuria, by the exercise electrocardiography and to assess the role of microalbuminuria as a marker for detecting silent coronary artery disease (CAD) and role of other conventional CAD risk factors in diabetic patients in development of SMI. Methods: A total of 60 patients with type 2 diabetes mellitus who were dipstick negative for macroalbuminuria and had no history suggestive of CAD or ECG abnormality were taken. Out of 60 patients 30 patients were positive for microalbuminuria by Micral Test® II sticks and 30 were tested negative for microalbuminuria. Subsequently, they were divided into case and control groups. Results: The risk of undetected CAD was increased in male Type 2 diabetics (p <0.05) and in the presence of Microalbuminuria (p <0.05). A positive correlation was found between exercise time and amount of work performed during treadmill test (TMT). A positive TMT with angiographically proven significant coronary stenosis is higher in male and in patients having microalbuminuria. Conclusions: Patients with T2DM and microalbuminuria have significant association with SMI as proven by TMT and coronary angiography. Patient have SMI with severe disease might benefit from revascularization. Patients with less severe disesase may benefit from drug and lifestyle interventions.

Risk factors for silent myocardial ischemia in patients with well-controlled essential hypertension.

Silent myocardial ischemia (SMI) is frequently observed in patients with essential hypertension (EH). The major risk factor for SMI is uncontrolled blood pressure (BP), but SMI is also observed in patients with well-controlled BP. To evaluate the prevalence of SMI and the factors associated with SMI in EH patients with well-controlled BP. The medical records of 859 EH patients who underwent simultaneous 24-h ambulatory blood pressure monitoring (ABPM) and 24-h ambulatory electrocardiogram recording (AECG) were retrospectively evaluated. Each SMI episode was characterized by: (a) ST segment depression ≥0.5mm; (b) duration of ST segment depression >60s; and (c) reversibility of the ST segment depression. Overall 126 EH patients (14.7%) had at least one episode of SMI. The SMI events were more frequent among patients with poorly controlled compared to those with well-controlled BP [86/479 (17.95%) vs. 40/380 (10.52%), p<0.01]. Among EH patients with well-controlled BP, current and past smoking as well as the presence of an additional metabolic syndrome (MetS) constitutive element (obesity, impaired fasting glucose level or dyslipidemia) were significantly associated with the occurrence of SMI. In all EH patients with well-controlled BP and AECG evidence of SMI, there were one or more coronary artery stenotic lesions greater than 50% found at coronary angiography. In EH patients who are current smokers, or have one or more additional components of a MetS there is markedly reduced benefit associated with good BP control with regard to the occurrence of myocardial ischemia: in this patient category, an AECG may help detect this condition.