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Silent myocardial ischaemia and left ventricle hypertrophy in diabetic patients
P Valensi1, R N Sachs, B Lormeau
1Service d'Endocrinologie-Diabétologie-Nutrition, Hôpital Jean Verdier, Bondy, France.
Insights
Diabetic patients with left ventricular hypertrophy are more prone to silent myocardial ischemia. The ECG stress test is the most accurate method for detecting this condition in such patients.
Area of Science:
- Cardiology
- Diabetology
- Diagnostic Imaging
Background:
- Diabetic patients often have asymptomatic cardiovascular disease.
- Left ventricular hypertrophy (LVH) is a common comorbidity in diabetes.
- Silent myocardial ischemia (SMI) poses a significant risk in this population.
Purpose of the Study:
- To assess noninvasive techniques for detecting SMI in diabetic patients.
- To identify factors associated with SMI, especially LVH.
- To compare the diagnostic accuracy of different tests for SMI.
Main Methods:
- Evaluated 92 asymptomatic diabetic patients with cardiovascular risk factors.
- Utilized ECG stress test, thallium-201 myocardial scintigraphy, ambulatory ECG monitoring, and echocardiography.
- Coronary angiography performed for correlation.
Main Results:
- 30.4% of patients showed evidence of SMI.
- Coronary stenosis was infrequent (<10%) overall but more common in patients with LVH.
- ECG stress test demonstrated higher positive predictive values (100%) in patients with LVH compared to those without (11%).
Conclusions:
- SMI detection should be prioritized in diabetic patients with LVH.
- The ECG stress test is a highly accurate method for identifying SMI in diabetic patients with LVH.
Abstract:
The purpose of this study was to evaluate the ability of three noninvasive techniques to detect silent myocardial ischaemia and analyse the factors associated with this condition, particularly left ventricular hypertrophy, in diabetic patients. An ECG stress test, a thallium-201 myocardial scintigraphy with dipyridamole intravenous infusion, ambulatory 48 h ECG monitoring and an echocardiographic study were performed in 92 diabetic patients without cardiac symptoms but with > or = 2 additional cardiovascular risk factors. At least one of these tests was positive in 28 patients (30.4%), suggesting silent myocardial ischaemia. Twenty-four of these patients had a coronary angiography which showed significant coronary stenosis in only 9 cases. An accurate echocardiographic tracing was obtained in 79 patients, particularly in 7 of the 9 with coronary stenosis. Left ventricular hypertrophy was detected in 34 patients, 6 of whom had coronary stenosis. In patients with left ventricular hypertrophy, the positive predictive values of myocardial scintigraphy and the ECG stress test were respectively 50% and 100%, as compared to only 33% and 11% in those without hypertrophy. In summary, coronary stenoses were found in < 10% of asymptomatic diabetic patients with > or = 2 cardiovascular risk factors, but more frequently in individuals with left ventricular hypertrophy. Thus, silent myocardial ischaemia should be searched for first in diabetic patients with hypertrophy, for which the stress test was the most accurate detection method in this study.