Screening for silent myocardial ischaemia in patients with type 2 diabetes mellitus: a quest to improve selection of the target screening population

Keyzer, Eva De; Kerkhove, Dirk; Camp, Guy Van; Sutter, Johan De; Achtergael, Wim; Keymeulen, Bart; Weytjens, Caroline

doi:10.1080/ac.66.6.2136954

Cited by 3 publications

(4 citation statements)

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“…Considering that the early decline of LVEF is associated with development of the subsequent cardiomyopathy [11] and the early treatment of cardiotoxicity can lead to recovery of LVEF [21], thus early detection is essential. Estimating the underlying cardiovascular risk factors, detecting temporary events, and identifying subclinical changes may be helpful in the early detection and prediction of subsequent cardiomyopathy [22]. …”

Section: Discussionmentioning

confidence: 99%

Early Cardiac Function Monitoring for Detection of Subclinical Doxorubicin Cardiotoxicity in Young Adult Patients with Breast Cancer

Chung

Jin

et al. 2013

J Breast Cancer

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PurposeAs doxorubicin cardiotoxicity is considered irreversible, early detection of cardiotoxicity and prevention of overt heart failure is essential. Although there are monitoring guidelines for cardiotoxicity, optimal timing for early detection of subclinical doxorubicin cardiotoxicity is still obscure. The purpose of this study is to determine optimal timing of cardiac monitoring and risk factors for early detection of doxorubicin cardiotoxicity in young adult patients with breast cancer.MethodsMedical records of 1,013 breast cancer patients diagnosed from January 2009 to December 2010 is being reviewed and analyzed. Properly monitored patients are defined as patients who underwent transthoracic echocardiography before and after the chemotherapy. The definition of subclinical cardiotoxicity (SC) either decreases left ventricular ejection fraction (LVEF) more than 10% or the LVEF declines under 55% from baseline without heart failure symptoms.ResultsTwenty-nine out of 174 (16.7%) properly monitored young adult female patients (mean age, 52±10 years old) developed SC. The mean interval of cardiac evaluation of SC group was 5.5±3.0 months. Among the risk factors, the history of coronary artery disease, cumulative dose of doxorubicin ≥300 mg/m2 and use of trastuzumab after doxorubicin therapy were associated with development of SC. At cumulative dose of doxorubicin 244.5 mg/m2, SC can be predicted (sensitivity, 71.4%; specificity, 70.9%; area under the curve, 0.741; 95% confidence interval, 0.608-0.874; p=0.001).ConclusionIn young adult patients with breast cancer, SC was common at cumulative dose of doxorubicin <300 mg/m2 and early performance of cardiac monitoring before reaching the conventional critical dose of doxorubicin might be a proper strategy for early detection of SC.

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Section: Discussionmentioning

confidence: 99%

Early Cardiac Function Monitoring for Detection of Subclinical Doxorubicin Cardiotoxicity in Young Adult Patients with Breast Cancer

Chung

Jin

et al. 2013

J Breast Cancer

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“…1 Type II diabetes is characterized by insulin insensitivity, increases in circulating glucose levels, and increases in circulating inflammatory factors. 2 Although cardiovascular disease and Type II diabetes can occur independently in individuals, many people diagnosed with Type II diabetes will develop cardiovascular disease if their diabetes is left untreated. Thus, reducing the prevalence of Type II diabetes is likely to result in a reduction in the prevalence of cardiovascular disease (http://www.nhlbi.nih.gov/health/health-topics/topics/dhd/).…”

Section: Introductionmentioning

confidence: 99%

Potential Contribution of Work-Related Psychosocial Stress to the Development of Cardiovascular Disease and Type II Diabetes: A Brief Review

Krajnak

2014

Environ�Health�Insights

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Two of the major causes of death worldwide are cardiovascular disease and Type II diabetes. Although death due to these diseases is assessed separately, the physiological process that is attributed to the development of cardiovascular disease can be linked to the development of Type II diabetes and the impact that this disease has on the cardiovascular system. Physiological, genetic, and personal factors contribute to the development of both these disorders. It has also been hypothesized that work-related stress may contribute to the development of Type II diabetes and cardiovascular disease. This review summarizes some of the studies examining the role of work-related stress on the development of these chronic disorders. Because women may be more susceptible to the physiological effects of work-related stress, the papers cited in this review focus on studies that examined the difference in responses of men or women to work-related stress or on studies that focused on the effects of stress on women alone. Based on the papers summarized, it is concluded that (1) work-related stress may directly contribute to the development of cardiovascular disease by inducing increases in blood pressure and changes in heart rate that have negative consequences on functioning of the cardiovascular system; (2) workers reporting increased levels of stress may display an increased risk of Type II diabetes because they adopt poor health habits (ie, increased level of smoking, inactivity etc), which in turn contribute to the development of cardiovascular problems; and (3) women in high demand and low-control occupations report an increased level of stress at work, and thus may be at a greater risk of negative health consequences.

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“…Diabetic complications such as retinopathy, nephropathy and neuropathy showed not to be significantly associated with either test abnormality or marked perfusion defects. In addition, traditional cardiac risk factors (male gender, hypertension, smoking and family history, or dyslipidaemia), previously reported as risk factors for CAD and poor outcome (De Keyzer et al, 2011) were not associated with SMI in working-age T2DM patients.…”

Section: Discussionmentioning

confidence: 99%

“…SPECT could accurately assess both myocardial perfusion and ventricular function in diabetic patients, providing important information for their management and is helpful in these situations (De Keyzer et al, 2011). Moreover, left ventricular (LV) function analysis in SPECT can enhances its prognostic and diagnostic ability, particularly in the prediction of SMI (Sharir et al, 1999).…”

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confidence: 99%

Prevalence of silent myocardial ischemia in working-age patients with type 2 diabetes mellitus

Kisko¹,

Vereb²,

Dobransky³

et al. 2017

Zdravje Delovno Aktivne Populacije / Health of the Working-Age Population

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Introduction: Data confirm a relatively high prevalence of silent myocardial ischemia (SMI) in elderly patients with type 2 diabetes mellitus (T2DM), while no data are available regarding working-age subjects (≤60 years). Methods: Medical records of 192 patients with T2DM aged ≤60 years (110 male patients; 57.3%), who had undergone myocardial perfusion imaging (MPI) between 2010 and 2014 followed by coronary angiography in case of abnormal result, were retrospectively analysed. Results: MPI was positive in 35 patients (18.2%); of those 31 (88.6%) had angiographically confirmed coronary stenosis. The positive predictive value of the MPI for predicting angiographic coronary stenosis in this age subgroup was 88.9%. Univariate analysis revealed post-stress LVEF drop ≥5% (p<0.03) and NT-proBNP levels detected in stress (p<0.05) to be associated with greater risk of ischemia in workingage T2DM patients. In multivariate analysis, LVEF drop ≥5% (p< 0.03) remained an independent predictor of SMI. Conclusion: Prevalence of SMI in diabetic working-age patients was similar to that observed in studies of subjects over 65 years-old. Poststress LVEF drop ≥5% and NT-proBNP levels can contribute to more precise identification of SMI. Our data suggest that "aggressive" management strategy should be implemented to reduce the risk of cardiac events in T2DM patients of working-age.

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Screening for silent myocardial ischaemia in patients with type 2 diabetes mellitus: a quest to improve selection of the target screening population

Abstract: Known risk factors for myocardial ischaemia were identified as significantly influencing the prevalence of SMI. No improvement in diagnostic yield could be identified by selecting the screening population using predicted life expectancy tables.

Cited by 3 publications

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Early Cardiac Function Monitoring for Detection of Subclinical Doxorubicin Cardiotoxicity in Young Adult Patients with Breast Cancer

Early Cardiac Function Monitoring for Detection of Subclinical Doxorubicin Cardiotoxicity in Young Adult Patients with Breast Cancer

Potential Contribution of Work-Related Psychosocial Stress to the Development of Cardiovascular Disease and Type II Diabetes: A Brief Review

Prevalence of silent myocardial ischemia in working-age patients with type 2 diabetes mellitus

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