Silent Myocardial Ischemia In Type Research Articles

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.

Low Levels of Vitamin D and Silent Myocardial Ischemia in Type 2 Diabetes: Clinical Correlations and Prognostic Significance.

Vitamin D deficiency has a pathogenetic and prognostic role in coronary artery disease and a key role in pain transmission. Diabetic patients have a higher risk of silent myocardial ischemia (SMI) due to diabetic neuropathy. We evaluated the correlation between SMI and Vitamin D serum levels in type 2 diabetic patients and assessed whether SMI patients had a worse survival rate than their symptomatic counterpart. We enrolled 253 patients admitted in our Cardiology Unit and compared them with 50 healthy volunteers. We created three sub-groups: symptomatic MI group (125, 32.4%); SMI group (78, 25.7%), and no-MI group (50, 41.9%). 25(OH)D levels (nmol/L) were lower in the SMI group (34.9 ± 5.8) compared to those in the symptomatic MI (49.6 ± 6.1; p = 0.01), no MI (53.1 ± 6.2; p = 0.001), and control groups (62.1 ± 6.7; p = 0.0001). 25(OH)D levels predicted SMI in diabetic patients, with an inverted odds ratio of 1.11 (p = 0.01). Symptomatic MI group survival was higher than the SMI one (6-year survival rate: 83 vs. 69%; p = 0.01). Diabetic patients with SMI had a higher mortality risk and showed lower 25(OH)D levels than the symptomatic group. This suggests the crucial role that vitamin D has in the pathogenesis of SMI.

Corrigendum

In the article titled ?Inflammatory cardiovascular risk markers and silent myocardial ischemia in type 2 diabetic patients? Vojnosanit Pregl 2022; 79(6): 584-590. (DOI: https://doi.org/10.2298/VSP201012010M) an error occurred in the byline such that the name of one of the authors was omitted. Listed the authors and their affiliations as: Gabrijela Malesevic, Snjezana Popovic-Pejicic, Ale-ksandra Markovic, Valentina Soldat-Stankovic University Clinical Center of the Republic of Srpska, Department of Endocrinology, Diabetes and Metabolic Diseases, Banja Luka, Bosnia and Herzegovina; University of Banja Luka, Faculty of Medicine, Banja Luka, Bosnia and Herzegovina The list of authors and their affiliations should read as: Gabrijela Malesevic, Snjezana Popovic-Pejicic, Aleksandra Markovic, Bojana Caric, Valentina Soldat-Stankovic University Clinical Center of the Republic of Srpska, Department of Endocrinology, Diabetes and Metabolic Diseases, Banja Luka, Bosnia and Herzegovina; University of Banja Luka, Faculty of Medicine, Banja Luka, Bosnia and Herzegovina. <br><br><font color="red"><b> Link to the corrected article <u><a href="http://dx.doi.org/10.2298/VSP201012010M">10.2298/VSP201012010M</a></b></u>

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.

Screening of Silent Myocardial Ischemia in Type 2 Diabetic Patients with Additional Atherogenic Risk Factors; The Applicability of Exercise Stress Test

Background: Silent myocardial ischemia (SMI) is a major clinical entity. SMI is highly prevalent and occurs more commonly in patients with diabetes. It is a predictor of mortality. Objective: To assess SMIs in type 2 diabetic patients with atherogenic risk factors using exercise stress test (EST) and to evaluate its applicability as a screening test. Methods: The study was conducted on sixty-three type 2 diabetic symptomless patients (37 male, 26 female patients), and without resting electrocardiographic (ECG) signs of ischemia. Patients were divided into 2 groups; Group I: patients with one or none of the atherogenic risk factors and Group II: patients with 2 or more of the atherogenic risk factors or peripheral vascular disease (PVD) alone. EST was carried out for all patients. Ischemia was diagnosed by ECG. Other tests were carried out as echocardiography, ultrasound Doppler of carotid arteries. Results: Only 57/63 (90.5%) patients had a diagnostic EST; 11 (19.3%) tested to be positive and 46 (80.7%) tested to be negative. ECG indicated ischemic features in 10 patients with positive EST. Ultrasound Doppler showed PVD in 3 out of 41 patients. Using multivariate analysis, there was a significant association of positive EST with PVD, hyperlipidemia, smoking, and hypertension. Conclusion: As the number of the atherogenic risk factors in diabetic patients increase, the incidence of SMI increases. Therefore, EST is applicable and practicable for screening of SMI in type 2 diabetic patients with 2 or more atherogenic risk factors. Keywords: Silent Myocardial ischemia, Exercise Stress test, Diabetes mellitus. Citation: Al-Ethary ZY, Alrikabi MB. Screening of silent myocardial ischemia in type 2 diabetic patients with additional atherogenic risk factors; the applicability of exercise stress test. Iraqi JMS. 2020; 18(1): 70-78. doi: 10.22578/IJMS.18.1.10

Treadmill test as a screening tool for detecting silent myocardial ischemia in type 2 diabetes patients: a case control study from Raipur, Chhattisgarh, India

Background: The incidence of diabetes mellitus (DM) is increasing substantially worldwide. CAD silently progresses over years in the diabetics. Diabetic individual appears to be less able to perceive some of the symptoms and signs of ischemia or may have asymptomatic ‘classic silent ischemia’. Thus, screening for early detection of asymptomatic CAD in type 2 diabetes may be helpful to prevent these catastrophic cardiac events and consequent deaths. Objectives of the study was to assess utility of TMT in Type 2 diabetic mellitus subjects to detect silent myocardial infarction.Methods: Hospital based observational analytical case control study was conducted in Department of Medicine in Dr BRAM Hospital Raipur during August 2016 to September 2018. Cases were 45 subjects of Type 2 Diabetes mellitus with normal ECG and controls were 45 subjects of Type 2 Diabetes Mellitus with abnormal resting ECG. Data analyzed using SPSS 17 version.Results: Majority i.e. 40% were found to be in fifth decade of their life. 71 (78.9%) male subjects and 19 (21.1%) female subjects. TMT was found positive in 8(17.8%) subjects with positive ECG changes whereas in 12(26.7%) subjects with no ECG changes. No significant difference was noted between distribution of any parameters except for hypertension which was found to be significantly higher in TMT positive subjects compared to TMT negative subjects.Conclusions: No significant difference was observed regarding TMT findings between T2DM subjects with and without ECG changes. Type 2 diabetes mellitus subjects with dyslipidemia, and hypertension are at higher risk of Positive TMT.

Radial Pulse Spectrum Analysis as Risk Markers to Improve the Risk Stratification of Silent Myocardial Ischemia in Type 2 Diabetic Patients.

Diabetic patients with silent myocardial ischemia (SMI) have elevated rates of morbidity and mortality and need intensive care and monitoring. An early predictor of SMI may lead to early diagnosis and medical treatment to prevent progression and adverse clinical events. Therefore, this paper was aimed to evaluate the radial pulse spectrum as risk markers to improve the risk stratification of SMI in type-2 diabetic patients; 195 diabetic patients at high-risk of SMI were enrolled. All patients underwent myocardial perfusion imaging and radial pressure wave measurement. The spectrum analysis of the radial pressure wave was calculated and transformed into Fourier series coefficients Cns and Pns. The risk of SMI (odds ratio: 4.46, 95%, C.I. 1.61–12.4, n}{}P<0.01n) was raised in diabetic patients classified high-risk group by C2. Multivariable regression analysis showed that C2 (n}{}P<0.05n) and ankle–brachial index [(ABI) n}{}P<0.05n)] were related to SMI (n}{}R=0.46n and n}{}P<0.05n). The myocardial ischemic score (MIS), combining C2, C3, and P5, the albumin-to-creatinine ratio (ACR), and ABI, presented an excellent risk stratification performance in enrolled patients (odds ratio: 5.78, 95%, C.I. 2.29–14.6, n}{}P<0.01n). The area under receiver operating characteristic curves for C2, C3, P5, ABI, ACR, and MIS were 0.66, 0.60, 0.68, 0.51, 0.56, and 0.74, respectively, in identifying SMI. This paper demonstrated that C2 was independently associated with the extent of SMI in multivariable regression analysis. Odds ratio and chi-square tests reflected that C2 could be an important marker for the risk stratification of SMI. Furthermore, MIS, adding radial pulse spectrum analysis to ACR and ABI, could significantly improve the risk stratification of SMI in type-2 diabetic patients compared to any single risk factor.

Prevalence of risk factors and asymptomatic carotid atherosclerosis in diabetic patients screened for silent myocardial ischemia by SPECT myocardial imaging.

The aim of the study was to evaluate whether there is any association between myocardial ischemia, common risk factors and carotid artery ultrasound parameters in asymptomatic type 2 diabetic (DMT2) patients. 60 asymptomatic DMT2 patients (pts) without known coronary artery disease (CAD) underwent one day rest Dypiridamole stress Tc-99m sestamibi single photon emission computed tomography myocardial perfusion scintigraphy (MPS). We used 17 segment models for perfusion analysis with the assessment of perfusion scores. Patients were studied for age, sex, hypertension, hyperlipidemia, hs-CRP, smoking, obesity and family history of cardiac disease. Color Ultrasound examination of carotid arteries was performed in all patients. 51 patients (pts) had hypertension, 48 pts had hyperlipidemia, 15 were smokers, 6 pts had BMI > 30 kg/m2 and 26 patients had positive family history for CAD. 18 (31%) patients had myocardial ischemia. Mild ischemia was found in 6 pts, moderate in 7 patients and severe ischemia in 5 patients. Carotid IMT was increased in 34 pts and 15 pts had carotid plaques. Mean c-IMT value in patients with normal MPS results was 0.7 ± 0.1; in moderate ischemia 0.9 ± 0.1 and in pts severe ischemia 1.0 ± 0.2. Multivariate analysis showed obesity, low HDL and increased diastolic blood pressure predictors of increased c-IMT. Increased pulse pressure (PP), age and non-HDL cholesterol were predictors for presence of carotid plaques. Multivariable analysis for prediction of stress induced ischemia showed OR 2.9 (95% CI 2.1-5.1) for male gender, OR 3.1 for systolic blood pressure (95% CI 1.9-3.8) and OR 2.8 for LDL cholesterol (95% CI 1.7-3.6). Our study has shown high prevalence of traditional risk factors and silent myocardial ischemia in type 2 diabetic patients, with the importance of SPECT imaging in selected diabetes type 2 patients. The study highlights the importance of screening for carotid atherosclerosis, which may be useful to identify diabetic patients at higher risk for coronary artery disease..

Detection of silent myocardial ischaemia in type 2 diabetes mellitus by exercise treadmill test

Detection of silent myocardial ischaemia in type 2 diabetes mellitus by exercise treadmill test

Screening for the Presence of Coronary Artery Disease

Screening for the Presence of Coronary Artery Disease

Diagnosis and Treatment of Erectile Dysfunction for Reduction of Cardiovascular Risk

We established erectile dysfunction as an often neglected but valuable marker of cardiovascular risk, particularly in younger men and men with diabetes. We also reviewed evidence that lifestyle change, combined with informed prescribing of pharmacotherapies used to mitigate cardiovascular risk, can improve overall vascular health and sexual functioning in men with erectile dysfunction. We performed a PubMed® search for articles and guidelines pertinent to relationships between erectile dysfunction and cardiovascular disease, cardiovascular and all cause mortality, and pharmacotherapies for dyslipidemia and hypertension. The clinical guidance presented incorporates the current literature and the expertise of the multispecialty investigator group. Numerous cardiovascular risk assessment tools exist but risk stratification remains challenging, particularly in patients at low or intermediate short-term risk. Erectile dysfunction has a predictive value for cardiovascular events that is comparable to or better than that of traditional risk factors. Interventional studies support lifestyle changes as a means of improving overall vascular health as well as sexual functioning. Statins, diuretics, β-blockers and renin-angiotensin system modifiers may positively or negatively affect erectile function. Furthermore, the phosphodiesterase type 5 inhibitors used to treat erectile dysfunction may have systemic vascular benefits. Erectile dysfunction treatment should be considered secondary to decreasing cardiovascular risk. However, informed prescribing may prevent worsening sexual function in men receiving pharmacotherapy for dyslipidemia and hypertension. As the first point of medical contact for men with erectile dysfunction symptoms, the primary care physician or urologist has a unique opportunity to identify those who require early intervention to prevent cardiovascular disease.

Silent Myocardial Ischemia (SMI) and its Association with Microalbuminuria in Type 2 Diabetes Mellitus (DM)

Background: As silent myocardial ischemia (SMI) is more common in diabetic population leading to the development of future coronary artery disease (CAD), so its early diagnosis is important. SMI can be diagnosed by conventional cardiac stress testing. Presence of SMI can also be suspected by microalbuminuria (MAU) because recently it is claimed that MAU is one of the important predictor for cardiovascular disease. Objective : The study was designed to explore the association between SMI & MAU in type 2 DM. Methods : It was a cross sectional study carried out in the Department of Biochemistry, BSMMU during the period of July 2006 to June 2008. One hundred diagnosed type 2 DM patients were selected from out patient department of BIRDEM. Enrolled study subjects were advised to do ETT and then categorized as ETT +ve & ETT-ve on the basis of ETT findings. Urinary micro albumin was measured in all study subjects. Unpaired t test, , chi square test, odds ratio were used to see the level of significance Results : Among the 100 type 2 diabetic subjects of both sexes 50 (male -24, female- 26) were ETT +ve designated as type 2 DM with silent MI and rest 50 ( male- 25 , female-25) were ETT –ve designated as type 2 DM without silent MI. 21 patients (42%) out of 50 type 2 DM with silent MI & 16 patients (32%) out of 50 type 2 DM without silent MI found to have microalbuminuria. Calculated odds ratio was 1.5. Conclusion: Microalbuminuria is a possible risk factor for SMI in type 2 DM. Urinary micro albumin can be used particularly as a screening test for early detection of SMI. DOI: http://dx.doi.org/10.3329/bsmmuj.v5i1.11016 BSMMU J 2012; 5(1):42-45

Osteoprotegerin, leptin and IL-6: Association with silent myocardial ischemia in type 2 diabetes mellitus

Diabetic patients often exhibit severe, asymptomatic coronary artery disease (CAD). The relationship between osteoprotegerin (OPG), inflammatory markers and silent myocardial ischemia remains to be elucidated. We recruited 45 type 2 diabetic patients and 33 healthy controls and assessed them for silent myocardial ischemia (SMI) by myocardial perfusion imaging. Patient blood was tested for OPG, IL-6 and leptin concentrations. OPG, leptin and IL-6 levels were found significantly elevated in diabetic patients (p < 0.001, p < 0.01, p < 0.05). Based on our classification of presence/absence of SMI in our diabetic group, we found that there was a significant association between SMI and the biomarkers IL-6 (p < 0.001), leptin (p < 0.001) and OPG (p < 0.05). In multivariate regression analyses, OPG was found to be significantly related to diabetes mellitus and to SMI. Age, sex and smoking increased the association between OPG and SMI. High OPG, leptin and IL-6 levels are associated with the presence and severity of SMI in type 2 diabetic patients.

Étude des facteurs de risque cardiovasculaire chez le diabétique de type 2 Tunisien récemment découvert

ObjectiveTo study the frequency of silent myocardial ischemia (SMI) in Tunisian patients with recent type 2 diabetes and identify cardiovascular risk factors directly in relation with SMI. Patients and methodsOne hundred and twenty diabetics and sixty healthy people have benefited from blood sampling, electrocardiogram and exercise test. ResultsThe frequency of SMI was 21% in diabetics and 3% in healthy people (P=0.01). Obesity and hypertension were higher in diabetics than in healthy people (P=0.001 and P<10−4). Using unvaried analysis for risk factors with the presence of SMI in diabetics, we found that age greater than 60yrs, male sex, sedentary and smoking were significantly correlated with SMI; respectively P=0.004, 0.01, 0.009 and 0.03. The SMI was found in 37% of diabetics with high blood pressure vs 8% in diabetics with normal blood pressure and was correlated with hypertriglyceridemia, hypoHDLemia and microalbuminuria. Patients with SMI had at least two cardiovascular risk factors apart from diabetes among those: age greater or equal to 60yrs, male sex, smoking, hypertension, dyslipidemia and family history of early coronaropathy. Chronic inflammation and hyperhomocysteinemia were significantly correlated to SMI; OR=4.2 and 3.8. In addition, SMI was found in one diabetic over three who had bad glycemic control. Using multivariate analysis, only age greater or equal to 60yrs, smoking, hypertension, hyperhomocysteinemia and hypertriglyceridemia were risk factors directly in relation with SMI in type 2 diabetes. ConclusionThe assessment of global cardiovascular risk from the moment of discovering type 2 diabetes and the early screening of SMI should be necessary.

A randomized study comparing isotope and echocardiography stress testing in the screening of silent myocardial ischaemia in type 2 diabetic patients

Aims This study aimed to compare the positive predictive value (PPV) of stress myocardial scintigraphy (SPECT) and of dobutamine echocardiography (DE) in the diagnosis of significant coronary artery stenosis (CAD) in asymptomatic type 2 diabetic patients, and to assess long-term clinical outcomes according to silent myocardial ischaemia (SMI) screening. Methods A total of 204 asymptomatic type 2 diabetic patients at high cardiovascular (CV) risk were prospectively randomized to undergo either SPECT ( n = 104) or DE ( n = 100). Coronary angiography was proposed in cases of SMI, with revascularization of suitable lesions. Intensive treatment of CV risk factors was prescribed for all patients. Death and myocardial infarction (MI) were recorded during the 3-year follow-up. Results Clinical characteristics were similar in the two testing groups. The prevalence of SMI and significant CAD were 13% and 4%, respectively, in the SPECT group vs 11% and 5%, respectively, in the DE group (not significant [NS]). The PPV for the detection of significant CAD was 29% for SPECT and 45% for DE (NS). Seven patients (3%) underwent initial revascularization. The 3-year rate of CV death and MI was 2.5%, and similar in both groups. Conclusion Rates of SMI and significant CAD in asymptomatic high-risk type 2 diabetic patients receiving intensive care of risk factors are low, and SPECT and DE are similar in the detection of SMI and CAD. Coronary revascularization and intensive CV risk-factor therapy are associated with a low rate of adverse CV events at 3 years, whichever stress test was used.

Dépistage de l’ischémie myocardique par l’échocardiographie de stress à la dobutamine chez le diabétique de type 2 à haut risque cardiovasculaire au Sénégal

Introduction Diabetes is a major risk factor for coronary artery disease witch may develop insidiously. Several non-invasive methods are used to detect silent myocardial ischaemia, especially in diabetic patients at high cardiovascular risk. We project to screen, by dobutamine stress echocardiography, silent myocardial ischaemia in type 2 diabetics in Senegal. Methodology We randomly recruited in hospital in Senegal type 2 diabetics aged at least 40 years and a dobutamine stress echocardiography was performed in those selected according to the French Society of Cardiology and the French Language Association for the Study of Diabetes and Metabolic Diseases. Results Dobutamine stress echocardiography was performed in 79 diabetics at high cardiovascular risk, including 56 women. The average age was 58.8 ± 11.8 years. The exam was positive in 67.1% of cases (53/79), with a predominance of motion abnormalities in anterior territory (83%). Cardiovascular risk factors associated with positivity of test were microalbuminuria ( p = 0.0001), inactivity ( p = 0.0001), dyslipidemia ( p = 0.0002), arterial hypertension ( p = 0.001), smoking (0.003) and male sex ( p = 0.004). Conclusion In Africa, dobutamine stress echocardiography has the advantage of its accessibility and its feasibility. Early detection of silent myocardial ischaemia in diabetics at high risk could optimize their care.

Screening of Silent Myocardial Ischemia in Type 2 Diabetic Patients

The prevalence of silent myocardial ischemia (SMI) is more frequent in diabetic patients and is associated with a worse prognosis (1). In order to prevent adverse cardiac events, current guidelines recommend detection of asymptomatic coronary artery disease (CAD) in type 2 diabetic patients with high cardiovascular (CV) risk (2,3). The ECG stress test is recommended but frequently inconclusive in type 2 diabetic patients. This study aimed to compare stress thallium-201 single photon emission computed tomography (SPECT) with dobutamine echocardiography (DE) for the screening of SMI and CAD in type 2 diabetic patients. The study was designed with 55 and 30% anticipated rates of positive SPECT and DE, …

Fibrinogen is associated with silent myocardial ischaemia in type 2 diabetes mellitus

Objective — Because traditional risk factors only partially explain coronary events, it is necessary to search for new ones like fibrinogen which has been related with coronary disease in healthy middle-aged adults.We attempted to determine the impact of fibrinogen on silent myocardial ischaemia (SMI) in diabetic patients.Methods and results — In a cross-sectional study, 134 type 2 diabetes patients with no history of cardiovascular disease were assessed for SMI. A personal history and physical evaluation of each patient was conducted as well as evaluation of cholesterol, glucose, fibrinogen, blood cell counts, glycated haemoglobin, urine albumin quantification, and urinalysis.A modified Bruce test was performed on all study participants to evaluate the presence of SMI.Results — Eleven patients had SMI (8.2%) that was associated with systolic, diastolic and mean blood pressure, hypertension, and fibrinogen.The correlation coefficient was obtained for quintiles of fibrinogen with the percentage of patients with SMI in that quintile (r = 0.97;95% = 0.66-0.99). Fibrinogen levels were associated with SMI. A receiver-operator curve analysis showed that the cutoff value for fibrinogen to predict SMI was 400 mg/dL (82% sensitivity, 81% specificity). A cutoff value of 306 mg/dL of fibrinogen would rule in the diagnosis of SMI (100% sensitivity, 17% specificity), while fibrinogen cutoff of 682 mg/dL would rule out SMI (100% specificity, 9% sensitivity).Conclusions — Fibrinogen strongly predicts SMI in diabetic patients and may identify individuals with high cardiovascular risk. Fibrinogen should be evaluated in diabetic patients for a more accurate cardiovascular evaluation.

Utilidad de la tomografía computarizada de emisión de fotón único sincronizada con el electrocardiograma para la detección de isquemia miocárdica silente en diabéticos tipo 2

Asymptomatic patients with severe coronary atherosclerosis may have a normal resting electrocardiogram and stress test.To assess the yield of Gated Single Photon Emission Computer Tomography (SPECT) for the screening of silent myocardial ischemia in type 2 diabetic patients.Electrocardiogram, stress test and gated-SPECT were performed on 102 type 2 diabetic patients aged 60+/-8 years without cardiovascular symptoms. AH subjects were also subjected to a coronary angiography whose results were used as gold standard.Gated-SPECT showed myocardial ischemia on 26.5% of studied patients. The sensibility, specificity accuracy, positive predictive value and negative predictive value were 92.3%, 96%, 95%, 88.8%, 97.3%, respectively. In four and six patients ischemia was detected on resting electrocardiogram and stress test, respectively. Eighty percent of patients with doubtful resting electrocardiogram results and 70% with a doubtful stress test had a silent myocardial ischemia detected by gated-SPECT There was a good agreement between the results of gated-SPECT and coronary angiography (k=0.873).Gated-SPECT was an useful tool for the screening of silent myocardial ischemia.

Frequency of Silent Myocardial Ischemia Detected by Thallium-201 SPECT in Patients with Type 2 Diabetes

Background: Silent myocardial ischemia (SMI) is more common in diabetic patients than among the general population. It is not yet established whether a routine screeni ng test for SMI is necessary, and which screening test would be most useful. The purpose of this study was to estimate the prevalence of SMI detected by Thallium-201 perfusion single photon emission compu ted tomography (SPECT) in type 2 diabetic patients. Methods: A total of 173 asymptomatic type 2 diabetic patients were included in the study. Thallium-201 perfusion SPECT was performed to screen for SMI. Results: Among the 173 patients, abnormal perfusion patterns were found in 11 patients. Coronary angiography was carried out for these patients, and significant coronary artery stenosis was found in ten of them (positive predictive value; 90.9%). There was a significant association between SMI and overt albuminuria (OR = 7.33, 95% CI, 1.825-29.437). Conclusion: Thallium-201 perfusion SPECT is not sensitive enough to identify SMI, but is accurate in detecting decreased myocardial perfusion. This may be a useful screening tool for detecting SMI in type 2 diabetic patients with impaired renal function. (Korean Diabetes J 33:225-231, 2009)