Silent Myocardial Ischemia Detection in Asymptomatic Diabetic Patients
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- Category: Vol. 81, March 2013
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Silent Myocardial Ischemia Detection in Asymptomatic Diabetic Patients,WALID M. ELTAHAWY, SALAMA H. OMAR, DINA Y. NASSAR, IMAN N. HAFEZ, SALAHELDIN H. DEMERDASH, MONA M. RYAN and MONA M. ABDELSALAM
Abstract
Diabetes mellitus is considered a coronary artery disease equivalent thereby elevating it to the highest risk category. Coronary atherosclerosis is the cause of death in three-fourth of diabetics. Silent myocardial ischemia is a common mani-festation of coronary heart disease (CHD) and its more in diabetics.
Objective: To assess the incidence and risk factors of silent myocardial ischemia in asymptomatic patients with type 2 diabetes mellitus.
Patients and Methods: 30 patients with type 2 diabetes, aged 35-68 years, with no known or suspected coronary artery disease, were assigned to stress-rest technetium-99m Sestamibi SPECT myocardial perfusion imaging.
Resulls: Thirty three (33.3%) of screened patients had perfusion defects suggestive of myocardial ischemia. These patients were older with longer duration of uncontrolled diabetes mellitus. Microalbuminuria (80%) was prevalent among patients with silent ischemia. These patients had exercised induced symptoms (60%) and ECG changes (40%) suggestive of ischemia. The risk for silent myocardial ischemia is increased also in smokers and in patients having positive family history of IHD. Male and female with type II diabetes mellitus are under comparable risk for CAD.
Conclusion: In light of the results of the present study we concluded that: Silent myocardial ischemia was found in 33.3% of diabetic patients. The risk for silent myocardial ischemia is increased with advanced age, longer duration of diabetes mellitus, smoking as well as positive family history of IHD. Patients with uncontrolled diabetes mellitus and/or with microalbuminemia are at higher risk for myocardial ischemia. The development of symptoms or the presence of ECG changes during stress test in asymptomatic diabetic patients should warrant a deeper and specific testing for CAD. Male and female with type II diabetes mellitus are under comparable risk for CAD.