Key result
Stress-induced ECG changes linked to ~4-fold higher odds of myocardial ischemia in asymptomatic diabetes.
Why the study?
The best diagnostic approach and optimal management of asymptomatic diabetic patients with suspected coronary artery disease remain uncertain.
Cross-Sectional (n=60)
No
Odds Ratio: 3.9 (95% CI 2.3–6.6)
May identify higher-risk asymptomatic diabetics for testing; leaves open prospective validation before practice change.
Cardiologia CROATICABackground: Diabetic patients have high prevalence of asymptomatic coronary artery disease (CAD) and silent myocardial infarctions.The dilemma of the best diagnostic approach to asymptomatic diabetic patients in relation to the optimal management is still ongoing.We wanted to evaluate the prevalence of myocardial ischemia in asymptomatic diabetic patients in relation to stress induced ECG changes and its influence on therapeutic decision.Methods: We evaluated 60 asymptomatic diabetic patients (pts) who underwent SPECT myocardial perfusion imaging (MPI) for detection of suspected CAD.ECG changes during pharmacological stress were compared with MPI results.We use 17 segment model for MPI quantitative analysis.Myocardial perfusion scores and functional parameters were evaluated.We assess the influence of MPI results on final patient management.Logistic regression analysis was used to assess the impact of diabetes on myocardial ischemia prevalence.Results: Stress inducible ischemia was found in 19 pts (33%), fixed defects in 13% and mixed defects in 9% of cases.The average percent of ischemia was 10%.Mildly abnormal scans were found in 7 patients (36%) -summed stress score (SSS) <8, moderate abnormality in 4 patients (22%) -SSS <13 and severely abnormal scans in 8 patients (42%) -SSS >13.Severe ischemia was only related to the duration of diabetes.Six pts with severe ischemia
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Peovska et al. (2013) conducted a cross-sectional in Asymptomatic diabetic patients with suspected coronary artery disease (n=60). Stress induced ECG changes vs. Absence of stress induced ECG changes was evaluated on Stress induced ischemia on SPECT MPI (OR 3.9, 95% CI 2.3-6.6). Stress-induced ECG changes (OR 3.9) and diabetes duration over 10 years (OR 2.4) were significantly associated with stress-induced ischemia in asymptomatic diabetic patients.
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