Introduction/Objective. Myocardial perfusion imaging (MPI) is clinically
useful for the evaluation of coronary artery disease (CAD) in patients with
diabetes mellitus (DM). However, the prevalence of ischemia and its ability
to predict future cardiac events is less clear. The aim was to determine the
incidence of cardiac events in diabetic patients and relationship between
them and MPI findings. Methods. Two cohorts of patients, 98 diabetics and
100 non-diabetics, with medium- to high-risk of CAD without previous
coronary revascularization were studied prospectively. All of them were
outpatients underwent 99mTc-sestamibi MPI with dipyridamole. The data about
cardiac events were collected during follow-up period of two years.
Results. Cardiac events occurred in 17.3% diabetics and in 8% non-diabetics
(p = 0.048). Diabetics had shorter estimated event-free time 24.7 months
(95% CI 23.2-26.2) versus non-diabetics 28.5 months (95% CI 27.4-29.5) (p =
0.046). The independent predictors of cardiac events were male sex (p =
0.010), previous myocardial infarction (p < 0.001), presence of the symptoms
of angina (p = 0.014) and all variables derived from MPI findings. After
adjustment for variables derived from MPI findings, the significant
predictors in diabetics were size of stress perfusion defect (p = 0.022),
summed stress score (p = 0.011) and summed difference score (p = 0.044).
Conclusion. In diabetic patients, the cumulative rate of cardiac events was
higher and the event-free survival was worse. MPI could help in prediction
of cardiac events in diabetics and the most important predictors were size
of stress perfusion defect, summed stress score and summed difference score.
Background/Aim. A special feature of Coronary Heart Disease (CHD) in patients
with type 2 diabetes (T2D) is that it is often asymptomatic and occurs as a
consecuence of cardiovascular auotonomic neuropathy. Dysregulation of the
autonomic nervous system is associated with elevated values of inflammatory
markers such as highly sensitive C-reactive protein (hs-CRP) and interleukin
6 (IL-6) which accelerate atherosclerosis and the occurrence of
cardiovascular complications in patients with T2D. The aim of the study was
to evaluate the importance of determining inflammatory cardiovascular risk
markers IL-6 and hs-CRP in screening for the presence of CHD in asymptomatic
patients with T2D. Methods: The study included 169 patients with T2D,
without any symptoms and signs of CHD. Ergometric testing proved or ruled
out the presence of silent CHD. The levels of hs-CRP and IL-6 were
determined by ELISA. Results: IL6 values were significantly higher in
patients with positive ergometric test (6.83?1.99 pg/mL) compared to
patients with negative ergometric test (3.04?1.39 pg/mL) (p<0.001). We also
found that hs-CRP values in patients with positive ergometric test was
significantly higher in comparison to patients with negative ergometric test
(6.37?2.25 vs 1.67?1.41 mg/L; p <0.001). Combinations of IL-6 and hs-CRP
with age, HbA1c values and duration of diabetes, presented through three
binary logistic regression models, are significant predictors of silent CHD
proven by ergometric testing, i.e. with their increase in the probability of
positive ergometric testing increased too (p <0.01). The sensitivity of the
associated finding of elevated IL-6 and hs-CRP values in the detection of
silent CHD by ergometric testing was 90% and the specificity was 86%.
Conclusion: hs-CRP and IL-6 are significant predictors of silent CHD, and
their determination could be recommended in improving cardiovascular risk
stratification in asymptomatic patients with T2D.
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