Prognostic relevance of symptoms versus objective evidence of coronary artery disease in diabetic patients

Zellweger, Michael J.; Hachamovitch, Rory; Kang, Xiaojian

doi:10.1016/j.accreview.2004.08.016

Cited by 78 publications

(141 citation statements)

References 22 publications

Supporting

Mentioning

121

Contrasting

Unclassified

Order By: Relevance

“…25,26) The most likely reason is that the symptoms of diabetes are not a reliable index for the presence of coronary artery disease. 27) Without identifiable risk factors, diabetic patients present no reliable reasons for coronary work-up and it is certain that many opportunities for appropriate treatment are being missed.…”

Section: Validity Of Coronary Ct Angiography For Screening Testmentioning

confidence: 99%

Role of Coronary CT Angiography in Asymptomatic Patients With Type 2 Diabetes Mellitus

et al. 2012

View full text Add to dashboard Cite

SummaryDiabetic patients with coronary artery disease are often asymptomatic, making appropriate care of such patients difficult. The purpose of this study was to investigate the prevalence of coronary lesions in asymptomatic diabetic patients. Coronary computed tomography (CT) angiography was performed in 120 consecutive diabetic patients (90 of whom were men, mean age 65, mean HbA1c 7.2%). Images from patients whose coronary artery calcium scores (CAC scores) were less than 400 were subjected to stenosis and plaque analysis. Significant stenosis was defined as coronary artery stenosis > 70%. High-risk plaque was defined as plaque having both a CT density < 30 Hounsfield Units (HU) and showing positive remodeling. Significant stenoses were identified in 30.5% of the patients. High-risk plaques were identified in 17.1% of the patients. Less than half of the high-risk plaques were obstructive plaques. There was a statistically significant association between significant stenosis and high-risk plaque by chi-square test (P = 0.022). We found significant stenosis even in patients whose CAC score = 0 at a rate of 5.0%. Using univariate logistic-regression analysis, we found that coronary risk factors associated with significant stenosis and high-risk plaque were dyslipidemia (P = 0.033) and current smoking (P = 0.030), respectively. We report for the first time, the prevalence of high-risk plaques in the arteries of patients with asymptomatic diabetes, as assessed by coronary CT angiography. (Int Heart J 2012; 53: 23-28) Key words: Diabetes mellitus, Coronary CT angiography, Asymptomatic diabetes, Vulnerable plaque A cute coronary syndrome is a major health concern in individuals with type 2 diabetes. The quantitative risk of myocardial infarction or cardiac death in diabetic patients is similar to that of patients with a history of myocardial infarction.1) Diabetic patients are also prone to sudden cardiac death.2) However, many diabetic patients are asymptomatic, or have atypical symptoms of coronary heart disease. The reason is thought to be related to autonomic denervation of the heart.3) Therefore, protection of these patients from cardiac events is difficult, and makes the identification of preclinical atherosclerosis even more pressing in diabetic patients.Acute coronary syndrome is mostly triggered by rupture of vulnerable plaque. Recent technological advances such as contrast-enhanced coronary CT angiography now allow the visualization of coronary artery plaques easily and less-invasively. Several studies have used these new techniques to characterize plaque features that are causally related to acute coronary syndrome.4-6) Therefore, it is quite possible that one can now identify vulnerable plaque on CT images.In this cross-sectional study, we analyzed coronary CT angiography findings of asymptomatic diabetic patients. We paid special attention to the analysis of plaque in terms of vulnerability. We believe our report is unique in assessing plaque vulnerability in asymptomatic diabetes. Methods Study des...

show abstract

Section: Validity Of Coronary Ct Angiography For Screening Testmentioning

confidence: 99%

Role of Coronary CT Angiography in Asymptomatic Patients With Type 2 Diabetes Mellitus

et al. 2012

View full text Add to dashboard Cite

show abstract

“…A study of asymptomatic diabetic patients without known CAD demonstrated a 2.2% annual critical event rate of myocardial infarction and cardiac deaths. [30] Another study demonstrated that 8.6% of patients with diabetes had cardiac events (cardiac deaths and myocardial infarction) compared with 4.5% in the nondiabetic cohort. [12] The critical event rate seemed lower in our study as long as one-year interim results were observed.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular events in Japanese asymptomatic patients with type 2 diabetes: a 1-year interim report of a J-ACCESS 2 investigation using myocardial perfusion imaging

Nakajima

Yamasaki

Kusuoka

et al. 2009

Eur J Nucl Med Mol Imaging

View full text Add to dashboard Cite

Purpose. Diabetic patients have a high risk for cardiovascular events. The role of myocardial perfusion imaging was investigated in asymptomatic diabetic patients to evaluate short-term prognosis in a Japanese population. Methods. A total of 506 asymptomatic patients ≥50 years of age who had carotid artery maximum intima-media thickness ≥1.1mm, urinary albumin excretion of ≥30mg/ g creatinine, with additional criteria of abdominal obesity, low HDL cholesterol, high triglyceride level and hypertension were enrolled and followed up over a3-year period. Gated SPECT with stress-rest protocol was performed and analyzed by summed defect scores and QGS software. One-year cardiovascular events were analyzed. Results. Myocardial ischemia was observed in 17% of patients, and abnormal perfusion findings of ischemia and/or scar were observed in 32% of patients. By the end of the one-year follow-up, 33 (6.5%) cardiovascular events occurred including 6 allcause deaths. Patients with summed stress score (SSS) >8 had a higher incidence of either death or cardiovascular events. Event-free survival rates for SSS 0-3, 4-8, 9-13 and ≥14 were 0.96, 0.95, 0.82 and 0.76, respectively. Multivariate Cox regression analysis showed that significant variables were SSS, history of cerebrovascular accident and electrocardiographic abnormality at rest. Conclusions. The one-year interim summary showed that cardiovascular events were significantly higher in patients with SPECT abnormality, although hard cardiac event rate was relatively low. Targeted treatment strategy is required for asymptomatic but potentially high-risk diabetic patients.

show abstract

“…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 "lowrisk" 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 non diabetics with normal MPS [11,32,39,41,42]. 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 non diabetics.…”

Section: Is There An Additive Value Of Ischaemia Imaging In Subjects mentioning

confidence: 97%

“…Its diagnostic and prognostic value has been demonstrated by a huge amount of evidence [12,[24][25][26][27][28][29][30][31][32]. MPS has excellent sensitivity and good specificity in the detection of CAD, 87% and 73%, respectively [33], as shown by a pooled analysis evaluating over 4000 patients.…”

Section: Is There An Additive Value Of Ischaemia Imaging In Subjects mentioning

confidence: 98%

“…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 non diabetics. Zellweger et al assessed the incidence of MPS evidence of CAD in diabetic patients without known CAD and the impact of symptoms and scintigraphic findings on prognosis [32]. Objective evidence of CAD was found in 39% of 826 asymptomatic diabetic patients, in 51% of 151 diabetic patients with shortness of breath, and in 44% of 760 diabetic patients with angina.…”

Section: Is There An Additive Value Of Ischaemia Imaging In Subjects mentioning

confidence: 99%

See 1 more Smart Citation

Screening tools for coronary artery disease (CAD) in asymptomatic subjects: the role of stress testing

2009

Schweiz Ärzteztg

View full text Add to dashboard Cite

Prognostic relevance of symptoms versus objective evidence of coronary artery disease in diabetic patients

Cited by 78 publications

References 22 publications

Role of Coronary CT Angiography in Asymptomatic Patients With Type 2 Diabetes Mellitus

Role of Coronary CT Angiography in Asymptomatic Patients With Type 2 Diabetes Mellitus

Cardiovascular events in Japanese asymptomatic patients with type 2 diabetes: a 1-year interim report of a J-ACCESS 2 investigation using myocardial perfusion imaging

Screening tools for coronary artery disease (CAD) in asymptomatic subjects: the role of stress testing

Contact Info

Product

Resources

About