Key result
Combined MDCT and TMT screening is linked to 0% cardiac death at 3 years in diabetic patients.
Why the study?
The current screening strategy for subclinical coronary atherosclerosis in asymptomatic diabetic patients is not sufficient in real clinical practice.
Does a screening strategy using MDCT and TMT prevent cardiac events in asymptomatic patients with type 2 diabetes?
Cohort (n=445)
Does a screening strategy using MDCT and TMT prevent cardiac events in asymptomatic patients with type 2 diabetes?
A screening strategy combining MDCT and TMT in asymptomatic diabetic patients may help guide treatment and minimize cardiovascular mortality.
Supports screening evaluation in asymptomatic diabetes; leaves open need for randomized confirmation of benefit.
BACKGROUND: The current screening strategy for subclinical coronary atherosclerosis in asymptomatic diabetic patients is not sufficient in real clinical practice. A new strategy was investigated that uses cardiac multi-detector computed tomography (MDCT) and a treadmill test (TMT). METHODS AND RESULTS: A total of 445 self-referred asymptomatic diabetic patients underwent cardiac MDCT. The treatment plan was determined according to the new strategy that uses MDCT and TMT. All patients underwent clinical follow-up and cardiac events were investigated. The incidence of subclinical atherosclerosis was 49.4%. The group without plaque underwent clinical follow-up without treatment and did not experience any cardiac events in 675.1 person-years of follow-up. Among patients with subclinical atherosclerosis without significant stenosis (n=136) who received medical treatment only, 11 patients experienced cardiac events over 326.4 person-years. The patients with significant stenosis (n=84) underwent TMT. Patients with positive TMT (n=14) underwent coronary angiograms and revascularization therapy was performed in all of them over 39.2 person-years. Patients with negative TMT (n=70) underwent medical treatment, and 27 of them experienced cardiac events. The incidence of cardiac death was 0% during 3 years of follow-up. CONCLUSIONS: The new strategy for detecting subclinical atherosclerosis on MDCT combined with TMT may be a useful method for minimizing the mortality rate from cardiovascular disease in asymptomatic diabetic patients.
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Jeong et al. (2014) conducted a cohort in Asymptomatic Type 2 Diabetes (n=445). Cardiac multi-detector computed tomography (MDCT) and treadmill test (TMT) screening strategy was evaluated on Cardiac death. A screening strategy using MDCT combined with TMT in asymptomatic diabetic patients resulted in a 0% incidence of cardiac death during 3 years of follow-up.
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