Can myocardial performance index predict the presence of silent ischemia in asymptomatic type 2 diabetic patients?
Mohammad M Al-Daydamony1, Mohammad A El-Tahlawi1, Ahmad Shawky1
1Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Insights
The Tei index can effectively predict silent myocardial ischemia in asymptomatic type 2 diabetes patients. This cardiac function measure offers valuable prognostic information for diabetic individuals at risk.
Area of Science:
- Cardiology
- Diabetology
- Echocardiography
Background:
- Coronary artery disease (CAD) significantly impacts morbidity and mortality in diabetic patients.
- Silent myocardial ischemia (SMI) is prevalent in diabetes, correlating with adverse outcomes.
- The Tei index assesses both left ventricular systolic and diastolic function.
Purpose of the Study:
- To evaluate the Tei index's utility in predicting SMI among asymptomatic type 2 diabetes mellitus (T2DM) patients.
- To determine if Tei index can identify subclinical cardiac dysfunction indicative of ischemia.
Main Methods:
- Asymptomatic T2DM patients without prior CAD or contraindications were enrolled.
- Standard clinical evaluation, ECG, echocardiography (including Tei index), and Holter monitoring were performed.
- Patients were stratified based on Holter-detected silent ischemia.
Main Results:
- A total of 200 patients were studied; 64 had SMI (Group I) and 136 did not (Group II).
- The Tei index was significantly elevated in patients with SMI (P<.00001).
- Tei index (≥0.6) demonstrated high predictive values: 85.9% sensitivity, 90% specificity, 78.6% PPV, and 88.6% NPV for SMI.
Conclusions:
- The Tei index is a valuable, non-invasive tool for predicting silent myocardial ischemia in asymptomatic T2DM patients.
- Elevated Tei index correlates with the presence and severity of silent ischemia.
Background:
Coronary artery disease (CAD) is an important cause of morbidity and mortality in patients with diabetes. Silent myocardial ischemia (SMI) is common in patients with diabetes and is associated with poorer prognosis. Myocardial performance index "Tei index" that reflects both left ventricular (LV) systolic and diastolic function. The aim of our study was to test the value of Tei index in prediction of SMI in asymptomatic patients with type 2 diabetes.
Patients And Methods:
Asymptomatic patients with type 2 diabetes were included in our study. We excluded patients with known CAD, previous revascularization, low ejection fraction, or abnormal ECG from the study. All patients had undergone history taking and clinical examination, ECG, echocardiography with measuring of Tei index and Holter monitoring for detecting silent ischemia.
Results:
A total of 200 patients were recruited. We divided our patients into two groups: Group I: 64 patients with SMI, Group II: 136 patients without SMI. There was no significant difference between the two groups regarding clinical and conventional echocardiographic data. Tei index was significantly higher in patients with silent ischemia (P<.00001). Sensitivity, specificity, positive, and negative predictive values of Tei index ≥0.6 in prediction of Holter detected silent ischemia were 85.9%, 90%, 78.6%, and 88.6%, respectively. We found a significant positive correlation between Tei index and number of ischemic episodes (r=.366, P=.0029).
Conclusion:
Measuring Tei index is helpful in predicting the presence of silent ischemia in asymptomatic patients with type 2 diabetes.
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