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Krajnc M, Pečovnik Balon B, Krajnc I. Non-traditional risk factors for coronary calcification and its progression in patients with type 2 diabetes: The impact of postprandial glycemia and fetuin-A. J Int Med Res 2019; 47:846-858. [PMID: 30616461 PMCID: PMC6381483 DOI: 10.1177/0300060518814080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective This study was performed to assess the impact of risk factors on the presence and progression of coronary calcification in patients with type 2 diabetes. Methods We prospectively enrolled 45 patients without cardiovascular or kidney disease. Coronary calcification was measured with multidetector computed tomography at baseline and 18 months. We also measured blood pressure; body mass index; serum levels of calcium, phosphate, and 25-hydroxyvitamin D; mineral bone density; and levels of alkaline phosphatase, parathormone, fetuin-A, high-sensitivity C-reactive protein, fibrinogen, albumin, homocysteine, lipids, HbA1c, and average preprandial and postprandial blood glucose at 18 months. Information about severe hypoglycemia and smoking was recorded. Spearman’s correlation coefficients were calculated. Multiple linear regression was used for the multivariate analysis. Results The median baseline calcium score was 63, and that at 18 months was 100. In the univariate analysis, albumin was significantly correlated with the baseline calcium score. Fetuin-A and postprandial glycemia were correlated with calcium score progression. In the multivariate model, postprandial glycemia and fetuin-A were independently associated with calcium score progression. Conclusions Fetuin-A and postprandial glycemia influence coronary calcification progression in patients with type 2 diabetes. The absence of some correlations could be due to pharmacological treatments for cardiovascular risk reduction.
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Affiliation(s)
- Mitja Krajnc
- 1 Department of Endocrinology and Diabetology, Maribor University Medical Centre, Slovenia
| | | | - Ivan Krajnc
- 2 Faculty of Medicine, University of Maribor, Slovenia
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Coronary Atherosclerosis Assessment by Coronary CT Angiography in Asymptomatic Diabetic Population: A Critical Systematic Review of the Literature and Future Perspectives. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8927281. [PMID: 29511691 PMCID: PMC5820580 DOI: 10.1155/2018/8927281] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 12/02/2017] [Indexed: 12/29/2022]
Abstract
The prognostic impact of diabetes mellitus (DM) on cardiovascular outcomes is well known. As a consequence of previous studies showing the high incidence of coronary artery disease (CAD) in diabetic patients and the relatively poor outcome compared to nondiabetic populations, DM is considered as CAD equivalent which means that diabetic patients are labeled as asymptomatic individuals at high cardiovascular risk. Lessons learned from the analysis of prognostic studies over the past decade have challenged this dogma and now support the idea that diabetic population is not uniformly distributed in the highest risk box. Detecting CAD in asymptomatic high risk individuals is controversial and, what is more, in patients with diabetes is challenging, and that is why the reliability of traditional cardiac stress tests for detecting myocardial ischemia is limited. Cardiac computed tomography angiography (CCTA) represents an emerging noninvasive technique able to explore the atherosclerotic involvement of the coronary arteries and, thus, to distinguish different risk categories tailoring this evaluation on each patient. The aim of the review is to provide a wide overview on the clinical meaning of CCTA in this field and to integrate the anatomical information with a reliable therapeutic approach.
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Tavares CAF, Wajchjenberg BL, Rochitte C, Lerario AC. Screening for asymptomatic coronary artery disease in patients with type 2 diabetes mellitus. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2017; 60:143-51. [PMID: 27191049 DOI: 10.1590/2359-3997000000170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 03/09/2016] [Indexed: 02/07/2023]
Abstract
Diabetes is a very frequent disease and it is estimated that its prevalence will continuously increase during the next two decades. The arteriosclerotic process in diabetic patients progresses earlier and more diffusely, and it is more accelerated in the diabetic patient than in the overall population. In diabetic subjects, acute myocardial infarction (AMI) and stroke are the leading causes of death, but the presence of arterial disease is not always detected before the development of the acute arterial event. Several times, AMI is asymptomatic or present nonspecific symptoms, and it is the initial form of presentation of coronary artery disease causing an important delay in initiating cardiovascular treatment in these patients. The purpose of this review article is to discuss how to screen and early diagnose the presence of coronary artery disease in asymptomatic diabetic patients, based on new available diagnostic resources. Currently, the most recommended technique used for screening coronary artery disease in these patients is myocardial perfusion scintigraphy or stress echocardiography because of greater sensitivity and specificity in relation to the exercise test. However, technological advances have enabled the development of new imaging diagnostic methods that are less invasive than conventional coronary angiography, and which gradually gain importance in the diagnosis of coronary artery disease as they show higher effectiveness with lower invasiveness and risk. Arch Endocrinol Metab. 2016;60(2):143-51.
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Affiliation(s)
- Carlos Augusto F Tavares
- Instituto do Coração do Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Bernardo Leo Wajchjenberg
- Instituto do Coração do Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Carlos Rochitte
- Instituto do Coração do Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Antonio Carlos Lerario
- Instituto do Coração do Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Tavares CAF, Rassi CHRE, Fahel MG, Wajchenberg BL, Rochitte CE, Lerario AC. Relationship between glycemic control and coronary artery disease severity, prevalence and plaque characteristics by computed tomography coronary angiography in asymptomatic type 2 diabetic patients. Int J Cardiovasc Imaging 2016; 32:1577-85. [PMID: 27432440 DOI: 10.1007/s10554-016-0942-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 07/14/2016] [Indexed: 01/03/2023]
Abstract
Evaluate whether glycemic control in type 2 diabetes (DM2) asymptomatic for coronary artery disease (CAD) affects not only the presence and magnitude of CAD but also the characteristics of plaque vulnerability using multidetector row computed coronary tomography (MDCT). Acute coronary syndrome (ACS) is frequently observed in asymptomatic DM2 patients. Positive vessel remodeling (PR) and low-attenuation plaques (LAP) identified by MDCT have been demonstrated to be characteristics of subsequent culprit lesions of ACS. However, little is known regarding plaque characteristics in asymptomatic diabetic patients and their relationship with glycemic control. Ninety asymptomatic DM2 patients, aged 40-65 years old, underwent MDCT. The presence of atherosclerotic obstruction, defined as coronary stenosis ≥50 %, and plaque characteristics were compared between two groups of patients with A1c < 7 and A1c ≥ 7 %. Of the 90 patients, 38 (42.2 %) presented with coronary atherosclerotic plaques, 11 had A1c < 7 % and 27 had A1c ≥ 7 % (p = 0.0006). Fourteen patients had significant lumen obstruction higher than 50 %: 3 in the A1c < 7 % group and 11 in the A1c ≥ 7 % group (p = 0.02). Non-calcified plaque was more prevalent in the A1c ≥ 7 % group (p = 0.005). In eleven patients, the simultaneous presence of two vulnerability plaque characteristics (PR and LAP) were observed more frequently in the A1c ≥ 7 group (n = 8) than in the A1c < 7 group (n = 3) (p = 0.04). Asymptomatic DM2 patients with A1c ≥ 7 % have a higher frequency of CAD and a higher proportion of vulnerable atherosclerotic coronary plaque by MDCT compared to patients with DM2 with A1c < 7 in our study.
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Affiliation(s)
- C A F Tavares
- Diabetes Group of the Heart Institute (Instituto do Coração -InCor) and Endocrinology Course (LIM 25), Clinics Hospital of the Medical School, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar 44, andar AB, Núcleo de diabetes e doença, Cardiovascular, Cerqueira César, São Paulo, SP, 05403-000, Brazil.
| | - C H R E Rassi
- Department of Radiology, Heart Institute (Instituto do Coração -InCor) of the Medical School, University of São Paulo, São Paulo, SP, Brazil
| | - M G Fahel
- Department of Radiology, Heart Institute (Instituto do Coração -InCor) of the Medical School, University of São Paulo, São Paulo, SP, Brazil
| | - B L Wajchenberg
- Diabetes Group of the Heart Institute (Instituto do Coração -InCor) and Endocrinology Course (LIM 25), Clinics Hospital of the Medical School, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar 44, andar AB, Núcleo de diabetes e doença, Cardiovascular, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - C E Rochitte
- Department of Radiology, Heart Institute (Instituto do Coração -InCor) of the Medical School, University of São Paulo, São Paulo, SP, Brazil
| | - A C Lerario
- Diabetes Group of the Heart Institute (Instituto do Coração -InCor) and Endocrinology Course (LIM 25), Clinics Hospital of the Medical School, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar 44, andar AB, Núcleo de diabetes e doença, Cardiovascular, Cerqueira César, São Paulo, SP, 05403-000, Brazil
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Dimitriu-Leen AC, Scholte AJ, van Rosendael AR, van den Hoogen IJ, Kharagjitsingh AV, Wolterbeek R, Knuuti J, Kroft LJ, Delgado V, Jukema JW, de Graaf MA, Bax JJ. Value of Coronary Computed Tomography Angiography in Tailoring Aspirin Therapy for Primary Prevention of Atherosclerotic Events in Patients at High Risk With Diabetes Mellitus. Am J Cardiol 2016; 117:887-93. [PMID: 26803383 DOI: 10.1016/j.amjcard.2015.12.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/16/2015] [Accepted: 12/16/2015] [Indexed: 01/28/2023]
Abstract
Aspirin use for primary prevention in patients at high risk with diabetes mellitus (DM) is often recommended under the assumption that most patients with DM have coronary artery disease (CAD). However, not all patients may have CAD. The present study evaluated, in 425 patients at high risk with DM (without chest pain syndrome or a history of cardiac disease), the prevalence of CAD on coronary computed tomography angiography (CTA). Moreover, the association between the presence and number of traditional cardiovascular (CV) risk factors and CAD (on coronary CTA) was evaluated. The median coronary artery calcium score was 29 (interquartile range 0 to 298). On coronary CTA, 116 patients (27%) had no CAD (defined as <30% stenosis). Of the 309 patients (73%) with any CAD (≥30% stenosis), 35% had obstructive CAD (≥50% stenosis). The number of traditional CV risk factors was not associated with the presence of any CAD (≥30% stenosis; p = 0.18) or obstructive CAD (≥50% stenosis; p = 0.13). Hypertension was the only traditional CV risk factor associated with a higher frequency of any CAD (≥30% stenosis; odds ratio = 2.21, 95% CI 1.43 to 3.41, p <0.001) and obstructive CAD (≥50% stenosis; odds ratio 2.03, 95% CI 1.33 to 3.11, p = 0.001). In conclusion, in patients at high risk with DM without chest pain syndrome, any CAD was ruled out by coronary CTA in 27%, whereas 65% of the patients did not have obstructive CAD. The number of CV risk factors was not associated with the presence of CAD. Hypertension was the only traditional CV risk factor that was associated with a higher frequency of CAD. These observations support potential use of coronary CTA to tailor aspirin therapy in patients at high risk with DM.
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Baroncini LAV, Borsoi R, Vidal MEB, Valente NJ, Veloso J, Pecoits Filho R. Assessment of dipyridamole stress echocardiography for risk stratification of diabetic patients. Cardiovasc Ultrasound 2015. [PMID: 26209102 PMCID: PMC4515011 DOI: 10.1186/s12947-015-0030-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Despite advances in medical therapy, cardiovascular disease, mainly coronary artery disease (CAD), remains the leading cause of mortality among patients with diabetes mellitus (DM). The objective of the present study was to assess the effectiveness of dipyridamole stress echocardiography in identify diabetic patients at high risk for cardiovascular events. METHODS Dipyridamole stress echocardiography was administered to 483 diabetic patients (294 women; mean age 63.41 ± 11.28 years) between July 2006 and December 2012. RESULTS Follow-up data were available for 264 patients (163 women; mean age 64.3 ± 10.5 years): 250 with a negative stress echocardiography and 14 with a positive stress echo. During a mean follow-up time of 18 ± 14 months, a cardiovascular event occurred in 18 (6.8%) patients, 12 (4.8%) in patients with a negative stress echo (n = 250) during a mean follow-up period of 20 ± 16 months and 6 (42%) in patients with positive stress echo (n = 14) during a mean follow-up of 13 ± 13 months. The positive and negative predictive values of stress echocardiography were 42% and 96% respectively. The accuracy value was 92%. A Cox regression model showed that CAD (hazard ratio [HR] 5.4, 95% confidence interval [CI] 1.9-15.4; p = 0.002) and positive stress echocardiography (HR 7.1, 95% CI 2.5-20.5; p < 0.001) were significant predictors of cardiovascular events. CONCLUSIONS For patients with diabetes, a negative dipyridamole stress echocardiogram predicts favorable outcome during the first year of follow-up. A new stress imaging test should be done after 12 months in diabetic patients.
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Affiliation(s)
- Liz Andréa Villela Baroncini
- Center of Health and Biological Sciences, Pontificia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Prado Velho, CEP: 80215-901, Curitiba, Paraná, Brazil.
| | - Rafael Borsoi
- Department of Internal Medicine, Medical School, Universidade Federal do Paraná, Rua XV de Novembro, 1299, Centro, CEP: 80060-000, Curitiba, Paraná, Brazil
| | - Maria Eugênia Bégué Vidal
- Medical School, Faculdade Evangélica, Rua Padre Anchieta, 2770, CEP: 80730-000, Curitiba, Paraná, Brazil
| | - Nathália Julim Valente
- Medical School, Faculdade Evangélica, Rua Padre Anchieta, 2770, CEP: 80730-000, Curitiba, Paraná, Brazil
| | - Juliana Veloso
- Pontificia Universidade Católica do Paraná, Curitiba, Brazil
| | - Roberto Pecoits Filho
- Center of Health and Biological Sciences, Pontificia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Prado Velho, CEP: 80215-901, Curitiba, Paraná, Brazil
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Dörr R, Stumpf J, Dalibor J, Simonis G, Spitzer SG. [Percutaneous coronary intervention versus bypass surgery in patients with diabetes and multivessel coronary disease. Coronary revascularization after FREEDOM]. Herz 2015; 39:331-42. [PMID: 24740094 DOI: 10.1007/s00059-014-4089-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Is coronary revascularization required in a patient with chronic stable coronary artery disease or can optimized medical therapy (OMT) alone be a sufficient alternative? This question has been controversially discussed for non-diabetics as well as for diabetics since the COURAGE and BARI 2D trials. According to our present knowledge, a patient will benefit from coronary revascularization only when either a non-invasive test method, such as single photon emission computed tomography (SPECT) or positron emission tomography (PET) myocardial scintigraphy, stress echocardiography or stress nuclear magnetic resonance imaging, can detect relevant, objective evidence of ischemia >10% of the left ventricular myocardium or when a pathological fractional flow reserve (FFR) <0.80 can be measured in an invasive procedure for an angiographically detectable coronary stenosis. If similar relevant ischemia can be non-invasively or invasively objectified in a patient with chronic stable multivessel coronary artery disease, the often controversially discussed question arises particularly in diabetics whether a percutaneous coronary intervention (PCI) with implantation of drug-eluting stents or coronary artery bypass surgery should be favored. The FREEDOM study (Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease), published in November 2012, was the first prospective randomized study to examine this issue in diabetic patients with multivessel coronary artery disease. Despite a higher rate of stroke in the surgical cohort, after an average follow-up time of 3.8 years a significant prognostic advantage in favor of bypass surgery was detected for a combined primary endpoint of all-cause mortality, nonfatal myocardial infarction and nonfatal stroke. Thus, in the new ESC guidelines on diabetes, pre-diabetes and cardiovascular diseases developed with the EASD of the European Society of Cardiology and published in 2013, coronary bypass surgery has a class I, level of evidence A recommendation for patients with diabetes mellitus, chronic stable multivessel coronary disease and a synergy between PCI with taxus and cardiac surgery (SYNTAX) score >22. The decision for or against a PCI/stent implantation or coronary bypass surgery in a diabetic patient with chronic stable multivessel coronary artery disease should therefore be made with the patient only after a detailed informed consent discussion and comprehensive explanation of both treatment options. In controversial cases, particularly with an equivocal SYNTAX score around 22, relevant comorbidities or anticipated method-specific complications, a one-stage ad hoc intervention during the diagnostic coronary angiography should be rejected in favor of a two-stage procedure with prior discussion of both treatment options in the heart team comprising noninvasive cardiologists, interventional cardiologists and cardiac surgeons.
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Affiliation(s)
- R Dörr
- Praxisklinik Herz und Gefäße, Forststr. 3, 01099, Dresden, Deutschland,
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Abstract
Diabetes is the leading cause of end-stage renal disease, blindness, and nontraumatic lower-limb amputation. The largest reductions in cardiovascular events are seen when multiple risk factors are addressed simultaneously. The benefit of aspirin as secondary prevention in patients with previous stroke or myocardial infarction has been well established. Regular, dilated eye examinations are effective in detecting sight-threatening diabetic retinopathy and have been shown to prevent blindness. The use of appropriate tools and clinical examination/inspection provides greater than 87% specificity in detecting diabetic peripheral neuropathy. Early treatment of risk factors, including hypertension, hyperglycemia, and dyslipidemia can delay or prevent diabetic nephropathy.
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Affiliation(s)
- Matthew P Gilbert
- Division of Endocrinology and Diabetes, Department of Medicine, College of Medicine, The University of Vermont, 62 Tilley Drive, South Burlington, VT 05403, USA.
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Myocardial Perfusion Imaging for Risk Stratification in Asymptomatic Individuals Without Known Cardiovascular Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-013-9253-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ferro A, Petretta M, Acampa W, Fiumara G, Daniele S, Petretta MP, Cantoni V, Cuocolo A. Post-stress left ventricular ejection fraction drop in patients with diabetes: a gated myocardial perfusion imaging study. BMC Cardiovasc Disord 2013; 13:99. [PMID: 24225073 PMCID: PMC3830540 DOI: 10.1186/1471-2261-13-99] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 11/11/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the relevance of stress-induced decrease in left ventricular ejection fraction (LVEF) in patients with type-2 diabetes. METHODS A total of 684 diabetic patients with available rest and post-stress gated myocardial perfusion single-photon emission computed tomography (MPS) data were enrolled. An automated algorithm was used to determine the perfusion scores using a 17-segment model. LVEF drop was considered significant if the post-stress LVEF was ≥5% below the rest value. Follow-up data were available in 587 patients that were followed for the occurrence of cardiac death, nonfatal myocardial infarction, or unstable angina requiring revascularization. RESULTS A post-stress LVEF drop ≥5% was observed in 167 (24%) patients. Patients with LVEF drop had higher summed stress score (p < 0.05), summed difference score (p < 0.001), and rest LVEF (p < 0.001) compared to patients without. Conversely, summed rest score, a measure of infarct size, was comparable between the two groups. At multivariable analysis, summed difference score and rest LVEF were independent predictors (both p < 0.001) of post-stress LVEF drop. Myocardial perfusion was abnormal in 106 (63%) patients with post-stress LVEF drop and in 296 (57%) of those without (p = 0.16). The overall event-free survival was lower in patients with post-stress LVEF drop than in those without (log rank χ2 7.7, p < 0.005). After adjusting for clinical data and MPS variables, the hazard ratio for cardiac events for post-stress LVEF drop was 1.52 (p < 0.01). CONCLUSIONS In diabetic patients stress-induced ischemia is an independent predictor of post-stress LVEF drop; however, a reduction in LVEF is detectable also in patients with normal perfusion. Finally, post-stress LVEF drop increases the risk of subsequent cardiac events in diabetic patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Napoli, Italy.
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Dayan A, Narin B, Biteker M, Aksoy S, Fotbolcu H, Duman D. Coronary calcium score, albuminuria and inflammatory markers in type 2 diabetic patients: associations and prognostic implications. Diabetes Res Clin Pract 2012; 98:98-103. [PMID: 22595190 DOI: 10.1016/j.diabres.2012.04.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 04/09/2012] [Accepted: 04/16/2012] [Indexed: 01/04/2023]
Abstract
AIMS To investigate the relationship of coronary artery calcium (CAC) scores with common carotid artery intima media thickness (CCA-IMT), albuminuria and inflammatory factors in type 2 diabetes. METHODS AND RESULTS 128 asymptomatic type 2 diabetic patients, with at least one cardiovascular risk factor in addition to diabetes, were included in the study. CAC scores, carotid arteries plaque formation and CCA-IMT were assessed. The patients were followed for a mean period of 36.6 ± 3.3 months. Linear regression analysis identified the logarithmically transformed (Ln) albuminuria (β=0.32, P=0.007), age (β=0.04, P=0.001) and the uric acid (β=0.13, P=0.04) as independent determinants of the CAC score. During follow-up period, cardiovascular events occurred in 18 out of 46 patients with CAC score ≥100 compared with 5 out of 82 patients with CAC score <100 (log rank, P<0.0001). Multivariate Cox proportional hazards analysis identified LnCAC score (P<0.0001), LnAlbuminuria (P=0.01) and uric acid (P=0.03) as independent predictors for cardiovascular events. CONCLUSIONS There was a significant relationship between CAC score, albuminuria and inflammation in patients with type 2 diabetes. LnCAC score together with LnAlbuminuria and uric acid were identified as independent predictors of cardiovascular events in these patients.
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Affiliation(s)
- Akın Dayan
- Haydarpaşa Numune Education and Research Hospital, Department of Internal Medicine, Istanbul, Turkey
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Diagnostic value of dobutamine stress Doppler tissue imaging in diabetic patients with suspected coronary artery disease. Egypt Heart J 2012. [DOI: 10.1016/j.ehj.2012.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Diogo CV, Suski JM, Lebiedzinska M, Karkucinska-Wieckowska A, Wojtala A, Pronicki M, Duszynski J, Pinton P, Portincasa P, Oliveira PJ, Wieckowski MR. Cardiac mitochondrial dysfunction during hyperglycemia--the role of oxidative stress and p66Shc signaling. Int J Biochem Cell Biol 2012; 45:114-22. [PMID: 22776741 DOI: 10.1016/j.biocel.2012.07.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 06/15/2012] [Accepted: 07/01/2012] [Indexed: 01/25/2023]
Abstract
Diabetes mellitus is a chronic disease caused by a deficiency in the production of insulin and/or by the effects of insulin resistance. Insulin deficiency leads to hyperglycemia which is the major initiator of diabetic cardiovascular complications escalating with time and driven by many complex biochemical and molecular processes. Four hypotheses, which propose mechanisms of diabetes-associated pathophysiology, are currently considered. Cardiovascular impairment may be caused by an increase in polyol pathway flux, by intracellular advanced glycation end-products formation or increased flux through the hexosamine pathway. The latter of these mechanisms involves activation of the protein kinase C. Cellular and mitochondrial metabolism alterations observed in the course of diabetes are partially associated with an excessive production of reactive oxygen species (ROS). Among many processes and factors involved in ROS production, the 66 kDa isoform of the growth factor adaptor shc (p66Shc protein) is of particular interest. This protein plays a key role in the control of mitochondria-dependent oxidative balance thus it involvement in diabetic complications and other oxidative stress based pathologies is recently intensively studied. In this review we summarize the current understanding of hyperglycemia induced cardiac mitochondrial dysfunction with an emphasis on the oxidative stress and p66Shc protein. This article is part of a Directed Issue entitled: Bioenergetic dysfunction, adaptation and therapy.
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Affiliation(s)
- Catia V Diogo
- CNC - Center for Neuroscience and Cell Biology, University of Coimbra, Portugal
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Myocardial perfusion imaging: a plus for coronary risk classification in diabetics. Eur J Nucl Med Mol Imaging 2012; 39:383-6. [DOI: 10.1007/s00259-012-2067-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Prognostic value of coronary artery calcium score in combination with cardiac stress sigle-photon emission tomography imaging in an asymptomatic population. COR ET VASA 2011. [DOI: 10.33678/cor.2011.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Tryniszewski W, Kuśmierczyk J, Maziarz Z, Goś R, Mikhailidis DP, Banach M, Rysz J, Pesudovs K. Correlation of the severity of diabetic retinopathy and the heart muscle perfusion in patients with type 2 diabetes. J Diabetes Complications 2011; 25:253-7. [PMID: 21439854 DOI: 10.1016/j.jdiacomp.2011.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2009] [Revised: 02/08/2011] [Accepted: 02/15/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective was to investigate whether microvascular disturbances in patients with type 2 diabetes (DM) as defined by retinal examination predict the existence of macrovascular disturbances found on radioisotopic perfusion examinations of the heart muscle. MATERIALS AND METHODS A total of 100 patients with type 2 DM and an additional cardiovascular risk factor were enrolled in the study. All patients underwent comprehensive ophthalmologic examination, including fundus color photography and fluorescein angiography, and were divided into three groups: group 1 (NoDR): met the inclusion criteria but had no diabetic retinopathy; group 2 (NPDR): had signs of nonproliferative diabetic retinopathy; group 3 (PDR): had signs of preproliferative or proliferative diabetic retinopathy. After collecting general medical history and clinical data, patients underwent heart muscle perfusion studies. All patients followed a 48-h protocol heart muscle perfusion examination in the rest state as well as after the standardized exercise test. Single photon emission computed tomography examination was performed. RESULTS In the PDR group, the impairment of the heart muscle perfusion at stress and rest was more frequent than in the NPDR and NoDR groups. Analysis of the heart muscle perfusion results for the three groups showed a significant relationship with the severity of microvascular complications observed in eye fundus examinations. CONCLUSIONS Comprehensive ophthalmologic assessment of the progression of diabetic retinopathy in patients with type 2 DM may be an indicator of heart muscle perfusion disturbance.
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Affiliation(s)
- Wiesław Tryniszewski
- Department of Radiological and Isotopic Diagnostics and Therapy, Medical University of Lodz, Poland.
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Hendel RC, Abbott BG, Bateman TM, Blankstein R, Calnon DA, Leppo JA, Maddahi J, Schumaecker MM, Shaw LJ, Ward RP, Wolinsky DG. The role of radionuclide myocardial perfusion imaging for asymptomatic individuals. J Nucl Cardiol 2011; 18:3-15. [PMID: 21181519 DOI: 10.1007/s12350-010-9320-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Robert C Hendel
- University of Miami Miller School of Medicine, Miami, FL, USA
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20
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21
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Dörr R. [Bypass surgery versus percutaneous coronary intervention in patients with diabetes mellitus]. Herz 2010; 35:182-90. [PMID: 20467930 DOI: 10.1007/s00059-010-3342-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
At present, in patients with diabetes mellitus and coronary multivessel disease no fixed general recommendation can be given in favor or to the disadvantage of surgical revascularization or in favor or to the disadvantage of percutaneous coronary intervention (PCI). In cases with an evidence-based indication for coronary revascularization because of clinical symptoms and/or proven ischemia, both therapeutic alternatives of bypass surgery or PCI are electable. The decision, which method of revascularization to prefer, must be based on close analyses of individual risk profile, individual comorbidity, and individual coronary morphology. With correct indication, both therapeutic methods are equivalent regarding the prognostically important combined endpoint of death, nonfatal myocardial infarction, and stroke. For PCI, however, there is a higher probability of restenosis depending on the complexity of lesion morphology, requiring more often repeat interventions or revascularizations. Before deciding in subfavor of or against a surgical or nonsurgical revascularization procedure, the complexity of the coronary artery disease should be analyzed, for example using the SYNTAX Score. In patients with SYNTAX Scores > or = 33 and no contraindications to bypass surgery, a surgical revascularization should be preferred. In the intermediate group with SYNTAX Scores between 23 und 32, the advantages and disadvantages of bypass surgery or PCI, for instance, the increased probability of restenosis with a higher necessity of repeat revascularizations after PCI, should be extensively discussed with the patient. In patients with SYNTAX Scores between 0 and 22, the nonsurgical, interventional therapy using drug-eluting stents (DES) can be recommended as an equivalent alternative to bypass surgery. In meta-analyses of randomized controlled trials and meta-analyses of large registries with PCI in patients with diabetes mellitus, clear advantages of DES in comparison with bare-metal stents (BMS) could be shown. Especially for patients with diabetes mellitus, there is still no clear evidence in favor of or against a special DES type or in favor of or against a special stent covering. Further sufficiently powered randomized controlled trials with hard clinical endpoints comparing bypass surgery with PCI (e.g., FREEDOM trial) and comparing different types of DES in patients with diabetes mellitus and clear PCI indications must be awaited, before further recommendations can be given.
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Affiliation(s)
- Rolf Dörr
- Praxisklinik Herz und Gefässe, Dresden, Germany.
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22
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Screening Asymptomatic Subjects for Subclinical Atherosclerosis. J Am Coll Cardiol 2010; 56:98-105. [DOI: 10.1016/j.jacc.2009.09.081] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 09/08/2009] [Accepted: 09/22/2009] [Indexed: 01/07/2023]
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Abstract
Coronary calcification has long been known to occur as a part of the atherosclerotic process, although whether it is a marker of plaque stability or instability is still a topic of considerable debate. Coronary calcification is an active process resembling bone formation within the vessel wall and, with the advances in CT technology of the past decade, can be easily quantified and expressed as a coronary artery calcium (CAC) score. The extent of calcium is thought to reflect the total coronary atherosclerotic burden, which has generated interest in using CAC as a marker of risk of cardiovascular events. The current consensus is that large amounts of CAC identify a highly vulnerable patient rather than a vulnerable plaque or vulnerable vessel. Indeed, CAC has incremental prognostic value beyond traditional risk factors in various subsets of the population. Furthermore, whereas the presence of CAC is associated with increased risk, a zero CAC score predicts excellent short-term to mid-term prognosis, even in high-risk patients. The advent of CT angiography has perhaps clouded the importance of CAC as a long-term marker of risk, as opposed to the presence of luminal stenoses that are associated with a more immediate risk of events.
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Affiliation(s)
- Nikolaos Alexopoulos
- Division of Cardiology, Department of Medicine, Emory University, Atlanta, GA, USA
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24
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Angadi SS, Gaesser GA. Pre-exercise cardiology screening guidelines for asymptomatic patients with diabetes. Clin Sports Med 2009; 28:379-92. [PMID: 19505622 DOI: 10.1016/j.csm.2009.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Coronary heart disease is a major cause of morbidity and mortality in persons with diabetes mellitus. Exercise is an important cornerstone in the treatment and management of diabetes but is also associated with a heightened risk of sudden cardiac death in those with occult coronary heart disease. Before beginning a physical activity program that involves anything greater than moderate intensity exercise, consideration should be given to screening asymptomatic persons with diabetes for silent myocardial ischemia.
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Affiliation(s)
- Siddhartha S Angadi
- Department of Exercise and Wellness, Arizona State University, 7350 E. Unity Avenue, Mesa, AZ 85296, USA.
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25
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Wiersma JJ, Verberne HJ, ten Holt WL, Radder IM, Dijksman LM, van Eck-Smit BLF, Trip MD, Tijssen JGP, Piek JJ. Prognostic value of myocardial perfusion scintigraphy in type 2 diabetic patients with mild, stable angina pectoris. J Nucl Cardiol 2009; 16:524-32. [PMID: 19536605 PMCID: PMC2708338 DOI: 10.1007/s12350-009-9111-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Revised: 06/05/2009] [Accepted: 06/05/2009] [Indexed: 11/18/2022]
Abstract
AIM To determine the prognostic value of reversible myocardial perfusion defects on myocardial perfusion scintigraphy (MPS) in patients with type 2 diabetes mellitus and mild anginal complaints. METHODS AND RESULTS In the MERIDIAN trial, patients with diabetes mellitus type 2, stable, mild anginal symptoms (Canadian Cardiovascular Society classification (CCS) I-II/IV) and reversible perfusion defects were randomized to either continued pharmacological treatment or early invasive treatment. In this sub analysis, the severity of the myocardial perfusion defect was related to the occurrence of cardiac death and non-fatal myocardial infarction, in 319 patients (63% male, 65 +/- 9 years). During follow-up (2.2 +/- 0.6 years), 14 patients had a cardiac event: 3 in 171 patients without myocardial ischemia and 11 in 148 patients with myocardial ischemia. Annual event rates rose from 0.8% to 5.8% with increasing severity of myocardial ischemia. Multivariable analysis identified the presence of severe myocardial ischemia (hazard ratio (HR) 5.45, 95%CI 1.89-15.71) and insulin use (HR 4.00, 95%CI 1.25-12.75) as independent predictors of cardiac events. CONCLUSIONS Type 2 diabetics with mild anginal symptoms with no or moderate myocardial ischemia have a low annual cardiac event rate. In patients with severe myocardial ischemia event rate increased 3-6 fold.
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Affiliation(s)
- Jacobijne J Wiersma
- Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
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26
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Oliveira JLM, Barreto-Filho JAS, Oliveira CRP, Santana TA, Anjos-Andrade FD, Alves ÉO, Nascimento-Junior AC, Góes TJS, Santana NO, Vasconcelos FL, Barreto MA, D'Oliveira Junior A, Salvatori R, Aguiar-Oliveira MH, Sousa ACS. Prognostic value of exercise echocardiography in diabetic patients. Cardiovasc Ultrasound 2009; 7:24. [PMID: 19480653 PMCID: PMC2700081 DOI: 10.1186/1476-7120-7-24] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Accepted: 05/29/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD) is the leading cause of death in diabetic patients. Although exercise echocardiography (EE) is established as a useful method for diagnosis and stratification of risk for CAD in the general population, there are few studies on its value as a prognostic tool in diabetic patients. The purpose of this investigation was to evaluate the value of EE in predicting cardiac events in diabetics. METHODS 193 diabetic patients, 97 males, 59.8 +/- 9.3 yrs (mean +/- SD) were submitted to EE between 2001 and 2006 and followed from 7 to 65 months with median of 29 months by phone calls and personal interviews with patients and their primary physician, and reviewing medical records and death certificates. The end points were cardiac events, defined as non-fatal myocardial infarction, late myocardial revascularization and cardiac death. Sudden death without another explanation was considered cardiac death. Survival free of end points was estimated by the Kaplan-Meier method. RESULTS Twenty-six cardiac events were registered in 24 individuals during the follow-up. The rates of cardiac events were 20.6 and 7% in patients with positive and negative EE, respectively (p < 0.001). Predictors of cardiac events included sedentary lifestyle, with RR of 2.57 95%CI [1.09 to 6.02] (P = 0.03) and positive EE, with RR 3.63, 95%CI [1.44 to 9.16] (P = 0.01). Patients with positive EE presented higher rates of cardiac events at 12 months (6.8% vs. 2.2%), p = 0.004. CONCLUSION EE is a useful method to predict cardiac events in diabetic patients with suspected or known CAD.
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Affiliation(s)
- Joselina LM Oliveira
- Department of Internal Medicine, Cardiology and Endocrinology Division, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Laboratory of Echocardiography of the São Lucas Hospital, Aracaju, Sergipe, Brazil
| | - José AS Barreto-Filho
- Department of Internal Medicine, Cardiology and Endocrinology Division, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Carla RP Oliveira
- Department of Internal Medicine, Cardiology and Endocrinology Division, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Thaiana A Santana
- Department of Internal Medicine, Cardiology and Endocrinology Division, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Fernando D Anjos-Andrade
- Department of Internal Medicine, Cardiology and Endocrinology Division, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Érica O Alves
- Department of Internal Medicine, Cardiology and Endocrinology Division, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Adão C Nascimento-Junior
- Department of Internal Medicine, Cardiology and Endocrinology Division, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Thiago JS Góes
- Department of Internal Medicine, Cardiology and Endocrinology Division, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Nathalie O Santana
- Department of Internal Medicine, Cardiology and Endocrinology Division, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Francis L Vasconcelos
- Department of Internal Medicine, Cardiology and Endocrinology Division, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Martha A Barreto
- Laboratory of Echocardiography of the São Lucas Hospital, Aracaju, Sergipe, Brazil
| | - Argemiro D'Oliveira Junior
- Department of Internal Medicine, School of Medicine, Federal University of the Bahia, Salvador, Bahia, Brazil
| | - Roberto Salvatori
- Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Manuel H Aguiar-Oliveira
- Department of Internal Medicine, Cardiology and Endocrinology Division, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Antônio CS Sousa
- Department of Internal Medicine, Cardiology and Endocrinology Division, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Laboratory of Echocardiography of the São Lucas Hospital, Aracaju, Sergipe, Brazil
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Stirrup J, Wechalekar K, Maenhout A, Anagnostopoulos C. Cardiac radionuclide imaging in stable coronary artery disease and acute coronary syndromes. Br Med Bull 2009; 89:63-78. [PMID: 19179343 DOI: 10.1093/bmb/ldp004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The increasing number of available cardiac imaging techniques has made the investigation of coronary artery disease (CAD) more complex. Appropriate patient referral depends on an understanding of the pre-test likelihood of CAD and the information provided by each test. SOURCES OF DATA This article describes myocardial perfusion scintigraphy (MPS) and summarizes evidence for its role in stable CAD and acute coronary syndromes with particular reference to current guidelines. AREAS OF AGREEMENT MPS has been extensively validated for the cost-effective diagnosis and prognosis of functionally significant CAD in both the acute and chronic settings. Its use is emphasized in the current NICE, national and international guidelines. AREAS OF CONTROVERSY Although normal MPS is associated with good outcomes, assessments of subclinical atherosclerosis such as coronary artery calcium scoring and computed tomography coronary angiography (CTA) demonstrate that non-flow-limiting CAD remains prognostically important. GROWING POINTS Technological developments, such as attenuation correction to improve diagnostic accuracy or analysis of left ventricular phase to detect dyssynchrony, carry the possibility of increasing the information that can be usefully gained from a single MPS study. AREAS TIMELY FOR DEVELOPING RESEARCH Of particular importance will be the role of MPS in an integrated imaging strategy that involves both anatomical and functional cardiac assessments. The use of hybrid technology that combines techniques such as MPS and CTA into a single imaging unit requires careful consideration with regard to diagnostic usefulness and cost-effectiveness.
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Affiliation(s)
- James Stirrup
- Barts and The London School of Medicine, Saint Bartholomew's Hospital, West Smithfield, London, UK
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28
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Anaya P. Diagnosis of subclinical coronary atherosclerosis: challenges and insight. ACTA ACUST UNITED AC 2008; 3:37-52. [DOI: 10.1517/17530050802647262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Celik T, Iyisoy A, Kardesoglu E, Isik E. The clinical significance of microvascular impairment in patients with pure uncomplicated diabetes mellitus. Int J Cardiol 2007; 131:123-4; author reply 128. [PMID: 17651846 DOI: 10.1016/j.ijcard.2007.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2007] [Accepted: 07/01/2007] [Indexed: 11/17/2022]
Abstract
Pure uncomplicated type 2 diabetes mellitus is 'coronary artery disease equivalent' in view of microvascular impairment in myocardium. We believe that the current study reemphasized clinical significance of coronary microvasculature assesment in patients with diabetes mellitus even though they had normal luminogram.
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30
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Johansen OE, Bjurö T, Endresen K, Blaasaas KG, Birkeland K, Aakhus S, Gullestad L. Heart rate adjustments and analysis of recovery patterns of ST-segment depression in type 2 diabetes. Int J Cardiol 2007; 127:129-32. [PMID: 17532067 DOI: 10.1016/j.ijcard.2007.04.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Accepted: 04/01/2007] [Indexed: 01/19/2023]
Abstract
AIMS To investigate the diagnostic value for coronary artery disease (CAD) detection of evaluating time- and heart rate (HR)-related ST-segment changes (the ST/HR-slope) and the post-exercise recovery pattern (the ST/HR-recovery loop) in patients with type 2 diabetes mellitus (T2DM). METHODS AND RESULTS Ninety-one patients (22 female, age 59+/-9 years) with T2DM (diabetes duration 6+/-6 years) performed an exercise ECG-test that was evaluated using the ST/HR slope (cut-off</=-2.4 microV/bpm) and -recovery loop patterns (abnormal versus normal) and compared to the conventional >/=1 mm ST-segment depression criterion and dobutamine stress echo-cardiography, all evaluated against coronary angiography irrespective of stress test results. Coronary angiography revealed CAD in 20 men and 3 women (25%). Sensitivity for the conventional exercise test and stress echocardiography was low (0.35 and 0.30), but increased significantly using the ST/HR-slope (0.45), the recovery loop (0.86) or the combined ST/HR slope and recovery loop criterion (0.91). The associations between angiographic CAD-detection and the different tests expressed by the Odds ratio demonstrated an added value of performing ST/HR analysis both over pre-test CAD risk profile and the established techniques. CONCLUSION T2DM patients capable of performing an exercise test could be assessed with the ST/HR-analysis for selecting patients to angiography. However, further studies including a higher number of patients are needed to confirm the diagnostic value of this approach.
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31
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Bax JJ, Inzucchi SE, Bonow RO, Schuijf JD, Freeman MR, Barrett EJ. Cardiac imaging for risk stratification in diabetes. Diabetes Care 2007; 30:1295-304. [PMID: 17259467 DOI: 10.2337/dc06-2094] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
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32
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Beller GA. Noninvasive Screening for Coronary Atherosclerosis and Silent Ischemia in Asymptomatic Type 2 Diabetic Patients. J Am Coll Cardiol 2007; 49:1918-23. [PMID: 17498575 DOI: 10.1016/j.jacc.2007.01.079] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Revised: 01/11/2007] [Accepted: 01/15/2007] [Indexed: 10/23/2022]
Abstract
Coronary artery disease (CAD) accounts for 65% to 80% of deaths in diabetic patients. The merits of screening asymptomatic type 2 diabetic patients for either (A) the presence of coronary atherosclerosis by imaging of coronary calcification using cardiac computed tomography or (B) silent ischemia by stress myocardial perfusion imaging (MPI) remain controversial. Some observers have advocated for such noninvasive screening in at least the subset of the diabetic population who have significant clinical CAD risk factors, so that the highest risk patients for future cardiac events can be identified and offered more aggressive intensive medical therapy or coronary revascularization and optimum medical therapy. Computed tomography coronary calcium scanning could be the first noninvasive screening test in these clinically high-risk diabetic patients, followed by stress MPI to detect silent ischemia in those who exhibit high coronary calcium scores.
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Affiliation(s)
- George A Beller
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
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Fox K, García MAA, Ardissino D, Buszman P, Camici PG, Crea F, Daly C, de Backer G, Hjemdahl P, López-Sendón J, Morais J, Pepper J, Sechtem U, Simoons M, Thygesen K. [Guidelines on the management of stable angina pectoris. Executive summary]. Rev Esp Cardiol 2007; 59:919-70. [PMID: 17162834 DOI: 10.1157/13092800] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Kim Fox
- Sociedad europea de cardiologia
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Al-Ozairi E, Middelbeek RJW, Horton ES. Cardiovascular risk assessment in type 2 diabetes mellitus. Curr Diab Rep 2006; 6:333-6. [PMID: 17076992 DOI: 10.1007/s11892-006-0001-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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35
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Bax JJ, Bonow RO, Tschöpe D, Inzucchi SE, Barrett E. The potential of myocardial perfusion scintigraphy for risk stratification of asymptomatic patients with type 2 diabetes. J Am Coll Cardiol 2006; 48:754-60. [PMID: 16904545 DOI: 10.1016/j.jacc.2006.04.077] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2005] [Revised: 04/06/2006] [Accepted: 04/18/2006] [Indexed: 11/25/2022]
Abstract
Patients with diabetes, in particular patients with type 2 diabetes, are at a 2- to 4-fold higher risk of cardiovascular mortality compared with their nondiabetic peers. Patients with diabetes are also more likely to have silent ischemia and less likely to survive a myocardial infarction than nondiabetic patients. Recent studies with electron beam computed tomography (EBCT) have shown that subclinical atherosclerosis is common in patients with diabetes, and studies with myocardial perfusion scintigraphy (with single-photon emission computed tomography) or stress echocardiography have demonstrated that between 25% and 50% of asymptomatic diabetic patients have ischemia during exercise or pharmacological stress and that a substantial proportion of these patients go on to develop major cardiovascular events within several years. Clearly, asymptomatic diabetic patients include a subset of individuals at high risk of cardiovascular disease who would benefit from improved risk stratification beyond that possible with risk factor scoring systems alone. Single-photon emission computed tomography, stress echocardiography, and possibly EBCT or multi-slice computed tomography, are emerging as valuable diagnostic tools for identifying asymptomatic diabetic patients who might require early and aggressive intervention to manage their cardiovascular risk.
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Affiliation(s)
- Jeroen J Bax
- Leiden University Medical Center, Leiden, The Netherlands.
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