Value of diagnostic tools for myocardial ischemia used in routine clinical practice to predict cardiac events in patients with type 2 diabetes mellitus: a prospective study

Abstract

Objective: To analyze tests used in routine clinical practice for the diagnosis of myocardial ischemia to predict the development of cardiac events in type 2 diabetic patients. Methods: The occurrence of cardiac events (new myocardial infarct, myocardial re-vascularization procedures, congestive heart failure, acute pulmonary edema, sudden death, and death after myocardial infarction or pulmonary edema) were prospectively assessed in a cohort of 135 type 2 diabetic patients after up to seven years of follow-up. At baseline, coronary artery disease was assessed by the WHO cardiovascular questionnaire, resting electrocardiogram, and stress myocardial scintigraphy. Results: Fortyeight cardiac events were observed in 41 patients (10.5 events/100 patients-year). In a Cox's proportional-hazard model only the presence of symptoms of coronary artery disease on the WHO cardiovascular questionnaire alone (RR= 2.13, 95% CI 1.11-4.07, P= 0.022) or in combination with abnormalities on resting ECG (RR= 2.03, 95% CI 1.05-3.92, P= 0.034) or on myocardial scintigraphy (RR= 1.89, 95% CI 1.001-3.57, P= 0.050) predicted cardiac events, adjusted for fasting plasma glucose, mean blood pressure, body mass index, peripheral vascular disease and diabetic nephropathy. Conclusion: The WHO cardiovascular questionnaire, a simple tool for the diagnosis of coronary artery disease, is a significant predictor of cardiac events in type 2 diabetic patients. RESUMO Valor dos Procedimentos Diagnósticos para Isquemia Miocárdica Usados na Prática Clínica de Rotina para Predição de Eventos Cardíacos em Pacientes com Diabetes Mellitus Tipo 2: Um Estudo Prospectivo.Objetivo: Analisar os testes usados na prática clínica de rotina para diagnóstico de isquemia miocárdica na predição do desenvolvimento de eventos cardíacos em pacientes com diabetes mellitus tipo 2 (DM2). Métodos: A ocorrência de eventos cardíacos (novo infarto do miocárdio [IM], procedimentos de re-vascularização miocárdica, insuficiência cardíaca congestiva, edema agudo de pulmão, morte súbita e morte após IM ou edema pulmonar) foi avaliada prospectivamente em uma coorte de 135 pacientes com DM2 após até 7 anos de acompanhamento. Na condição basal, a doença arterial coronariana (DAC) foi avaliada pelo questionário cardiovascular da OMS, eletrocardiograma de repouso e cintilografia do miocárdio sob stress. Resultados: 48 eventos cardíacos foram observados em 41 pacientes (10,5 eventos/100 pacientes-ano). No modelo de risco proporcional de Cox apenas a presença de sintomas de DAC no questionário cardiovascular da OMS isoladamente (RR= 2,13, 95% CI 1,11-4,07, P= 0,022) ou em combinação com anormalidades no ECG de repouso (RR= 2,03, 95% CI 1,05-3,92, P= 0,034) ou cintilografia do miocárdio (RR= 1,89, 95% CI 1,001-3,57, P= 0,050) predisseram eventos cardíacos, ajustados para a glicemia de artigo original

Polimorfismo K121Q do gene ENPP1 e cardiopatia isquêmica em pacientes com diabete melito

“…However, since all studied patients underwent the WHO cardiovascular questionnaire and rest ECG, we can state that in the group of patients without IHD 100% of these tests were negative. Furthermore, we had previously demonstrated 13 that the presence of IHD according the WHO cardiovascular questionnaire had a RR for cardiac events of 2.13 (95%CI 1.11-4.07; P = 0.022) even better than the risk conferred by resting ECG or myocardial scintigraphy. Furthermore, when WHO cardiovascular questionnaire was associated with a normal ECG the negative predictive value for cardiac events was 82.1%.…”

“…These diagnostic tools for myocardial ischemia in type 2 DM patients were previously evaluated in a prospective study 13 .…”

Cardiovascular autonomic neuropathy in type 2 diabetes mellitus patients with peripheral artery disease

“…Patients with type 2 diabetes were selected from a cohort of consecutive outpatients attending the Endocrine Division at Hospital de Clínicas de Porto Alegre. Details of the original cohort have been previously published [11]. From the original cohort of 98 patients with type 2 diabetes, 84 patients were available for evaluation.…”

Dietary fat composition and cardiac events in patients with type 2 diabetes

“…Presence of baseline ischemic heart disease, an exclusion criterion, was defined as: presence of angina and/or possible infarction, using a World Health Organization (WHO) cardiovascular questionnaire as previously standardized in patients with type 2 diabetes by our group [11], or abnormalities on resting electrocardiogram (Minnesota Codes: Q and QS patterns [1-1 to 1-3]; S-T junction and segment depression [4-1 to 4-4]; T-wave items [5-1 to 5-3], or complete left bundle branch block ). In those cases, the ischemic heart disease was always confirmed by exercise electrocardiogram or radionuclide myocardial perfusion imaging with stress (exercise or pharmacological) compatible with the presence of myocardial ischemia [12].…”