Non-invasive identification of severe coronary artery disease in patients with long-standing diabetes mellitus.
OBJECTIVE
To detect severe coronary artery disease in asymptomatic middle-aged diabetic patients exposed to coronary artery disease risk factors.


METHODS
Forty-four middle-aged patients (30 to 65 years of age) with a known duration of diabetes exceeding 10 years and at least one additional cardiovascular risk factor were studied. Patients were free of anginal chest pain and had a normal 12-lead ECG at rest. All patients underwent 24-hour ambulatory ECG, maximal bicycle exercise electrocardiography and intravenous dipyridamole thallium myocardial scintigraphy. If one of these 3 non-invasive tests revealed signs of myocardial ischaemia, a coronary angiography was performed.


RESULTS
Non-invasive investigation yielded the diagnosis of myocardial ischaemia in 9/44 patients (20%). Six of the 9 patients had significant coronary artery stenoses (> 70% narrowing) and 5 exhibited severe triple-vessel disease. With dipyridamole thallium scintigraphy, the positive predictive value for diagnosis of coronary artery disease was optimal.


CONCLUSIONS
In diabetic patients with additional coronary risk factors, periodical thorough clinical examination and resting ECG may fail to detect severe coronary disease. More sophisticated cardiovascular non-invasive tests should then be proposed as part of the periodical care of these patients.
Paillole
C
C
Department of Cardiology, Bichat Hospital, Paris, France.
Passa
P
P
Paycha
F
F
Juliard
J M
JM
Steg
P G
PG
Leblanc
H
H
Philippe
L
L
Gourgon
R
R
D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis* / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003925:Diabetic Angiopathies / Q000175:diagnosis* / Q000453:epidemiology; D004176:Dipyridamole; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D012307:Risk Factors; D013794:Thallium Radioisotopes
D013794:Thallium Radioisotopes; D004176:Dipyridamole