Identifying high-risk asymptomatic diabetic patients who are candidates for screening stress single-photon emission computed tomography imaging

Rajagopalan, Navin; Miller, Todd D.; Hodge, David O.; Frye, Robert L.; Gibbons, Raymond J.

doi:10.1016/j.jacc.2004.06.078

Cited by 197 publications

(109 citation statements)

References 36 publications

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“…Importantly, although a normal MPS study is generally associated with a low risk (< 1% annual risk of cardiac death or myocardial infarction), the challenge in a diabetic population is to define the elusive "low-risk" patient. To date, reports have consistently shown that normal MPS in diabetic populations is not associated with this low level of risk and, in direct comparisons, patients with diabetes are at significantly greater risk than nondiabetics with normal MPS [24,[26][27][28][29]. Similarly, in the setting of an abnormal MPS, the risk conferred by any given extent and severity of perfusion abnormality is greater in patients with diabetes than in nondiabetics.…”

Section: Prognosis Of Silent Cad In Diabetic Patientsmentioning

confidence: 97%

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Prognostic Significance of Silent Coronary Artery Disease in Type 2 Diabetes

Zellweger

2006

Herz

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The prevalence of obesity and diabetes is increasing rapidly. Coronary artery disease (CAD) represents the leading cause of death in diabetic patients. Diabetic patients are at a two- to fourfold risk of cardiovascular mortality compared with their nondiabetic counterparts. Silent myocardial ischemia more often occurs in diabetics than in nondiabetics. In general, the prevalence of silent CAD varies depending on the test used for patient screening and on the patient population screened. The prevalence of silent CAD is 6-23% in low-risk diabetic patients. In high-risk diabetic patients the prevalence may be as high as 60%. Over the last years it has been well recognized that silent CAD is not different from symptomatic CAD with respect to prognosis and adverse events. Particular diabetic patients therefore might benefit from routine CAD screening. CAD could be diagnosed at an earlier stage of disease and be treated accordingly. Myocardial perfusion SPECT, stress echocardiography and possibly computed tomography are emerging as effective screening tools beyond risk stratification by risk factor scoring systems alone. There are few studies suggesting that early intervention by medical or also revascularization strategies could lead to a better outcome in diabetic patients with evidence of silent CAD.

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Section: Prognosis Of Silent Cad In Diabetic Patientsmentioning

confidence: 97%

“…Rajagopalan et al examined angiographic findings and mortality rates in 826 asymptomatic diabetic patients with respect to MPS findings [24,25]. The mortality rate in high-risk patients was 5.9%, in intermediate-risk patients 5.0%, and in low-risk patients 3.6% (p < 0.001 for differences between groups).…”

Section: Prognosis Of Silent Cad In Diabetic Patientsmentioning

confidence: 99%

Prognostic Significance of Silent Coronary Artery Disease in Type 2 Diabetes

Zellweger

2006

Herz

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“…209,210 Although it is important to individualize clinical decision making, widespread screening for silent CAD in diabetes mellitus cannot be recommended at this time. 209 A variety of CAD screening tests [211][212][213][214][215][216][217][218][219][220][221][222][223][224][225][226][227][228][229] are available (Table 8). These include the simple, inexpensive, and noninvasive resting ECG, which may detect evidence of prior myocardial injury or ischemia.…”

Section: Subclinical Cad Assessmentmentioning

confidence: 99%

Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence

Fox¹,

Golden²,

Anderson³

et al. 2015

Circulation

321

131

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Abstract-Cardiovascular disease risk factor control as primary prevention in patients with type 2 diabetes mellitus has changed substantially in the past few years. The input provided by Drs Fox, Ershow, Nelson, and Fradkin is from their own perspective, and the opinions expressed in this article do not reflect the view of the National Institutes of Health, Department of Health and Human Services, or the US government. Dr Pignone is a member of the US Preventive Services Task Force. His contributions here represent his views alone and not necessarily those of the US Preventive Services Task Force.The American Heart Association and the American Diabetes Association make every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This document was approved by the American Heart Association Science Advisory and Coordinating Committee on April 30, 2015, the American Heart Association Executive Committee on May 22, 2015, and the American Diabetes Association on January 7, 2015.The American Heart Association requests that this document be cited as follows: Fox CS, Golden SH, Anderson C, Bray GA, Burke LE, de Boer IH, Deedwania P, Eckel RH, Ershow AG, Fradkin J, Inzucchi SE, Kosiborod M, Nelson RG, Patel MJ, Pignone M, Quinn L, Schauer PR, Selvin E, Vafiadis DK; on behalf of the American Heart Association Diabetes Committee of the Council on Lifestyle and Cardiometabolic Health, Council on Clinical Cardiology, Council on Cardiovascular and Stroke Nursing, Council on Cardiovascular Surgery and Anesthesia, Council on Quality of Care and Outcomes Research, and the American Diabetes Association. Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation. 2015;132:691-718. This article has been copublished in Diabetes Care.Copies: This document is available on the World Wide Web sites of the American Heart Association (my.americanheart.org) and the American Diabetes Association (www.diabetes.org). A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.Expert peer review of AHA Scientific Statements is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit http://my.americanheart.org/statements and select the "Policies and Development" link.

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“…Patients should have baseline ECGs to evaluate for Q waves, ST‐T changes, T wave inversions, and left bundle branch block, which previously have been shown to be predictive of CAD 25. Exercise ECG is not recommended, given abnormal baseline ECGs and overall poor exercise tolerance in this patient population.…”

Section: Cad In Patients With Esrdmentioning

confidence: 99%