The role of non-invasive imaging in the risk stratification of asymptomatic diabetic subjects.
OBJECTIVE
Coronary artery disease (CAD) is the leading cause of death in patients with diabetes. Patients often present with advanced and asymptomatic disease. Proposed strategies that may favourably affect CAD risk and outcomes in this patient population include identifying diabetic patients with subclinical disease at high risk of future cardiac events. The purpose of this article was to review the role of both atherosclerosis imaging tests (coronary calcium imaging and high-resolution ultrasound assessment of carotid intima-media thickness) and functional imaging techniques [stress echocardiography and radionuclide myocardial perfusion imaging (MPI)] in the diagnostic and prognostic evaluation of asymptomatic diabetic subjects.


RESULTS
We identified studies using MEDLINE searches (1966 to April 2005) and by reviewing reference lists. A comprehensive list of search terms was applied. All stress echocardiography and MPI studies evaluating the prevalence and/or prognostic value of myocardial ischaemia (n = 19) and coronary calcium imaging studies (n = 2) evaluating the prognostic value of subclinical atherosclerosis in diabetic patients were included.


CONCLUSIONS
Asymptomatic myocardial ischaemia can be detected in a significant proportion of diabetic subjects by non-invasive imaging tests such as MPI and stress echocardiography. The results of ongoing and future studies may be helpful in guiding the selection of asymptomatic diabetic subjects to undergo non-invasive imaging, establishing the cost-effectiveness of various testing strategies and their impact on prognosis.
Anand
Dhakshinamurthy Vijay
DV
Cardiac Imaging and Research Centre, Wellington Hospital (South Building), Wellington Road, St John's Wood, London NW8 9LE, UK. vdanand@hotmail.com
Lim
Eric
E
Lahiri
Avijit
A
Bax
Jeroen J
JJ
D002114:Calcinosis / Q000175:diagnosis*; D003324:Coronary Artery Disease / Q000175:diagnosis; D003925:Diabetic Angiopathies / Q000175:diagnosis*; D003952:Diagnostic Imaging / Q000379:methods* / Q000592:standards; D006801:Humans; D017202:Myocardial Ischemia / Q000175:diagnosis*; D018570:Risk Assessment / Q000592:standards; D012307:Risk Factors; D012680:Sensitivity and Specificity