Silent myocardial ischemia screening in patients with diabetes mellitus.
The prevalence of diabetes mellitus is fairly increasing, especially in the developing countries. Diabetes is a major cardiovascular risk factor; it often leads to severe cardiovascular complications, and coronary artery disease (CAD) is the main cause of death in diabetic patients. Silent myocardial ischemia (SMI) is more frequent in diabetic patients. The progress made in detection and treatment of CAD allows reconsidering the screening of SMI, in the hope that early CAD diagnosis leads to a more effective therapy and the decrease of cardiovascular complications and mortality. However, the benefit of systematic SMI screening remains discussed. Current guidelines recommend screening SMI in asymptomatic diabetic patients selected for high cardiovascular risk (i.e. with two or more other cardiovascular risk factors, or peripheral or carotid arterial disease, or proteinuria). ECG stress test can be recommended in first intention if maximal heart rate can be achieved. For patient with inconclusive ECG stress test, myocardial scintigraphy seems more accurate than stress echocardiography. Coronary angiogram should be performed in case of positive stress test. Further evaluations of systematic screening have to be conducted on broad randomized trial.
Barthelemy
Olivier
O
Hospital Group Pitié-Salpêtrière, Institute of Cardiology, and Université Paris, France. olivier.barthelemy@psl.aphp.fr
Le Feuvre
Claude
C
Timsit
José
J
D001794:Blood Pressure; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003925:Diabetic Angiopathies / Q000175:diagnosis*; D004562:Electrocardiography; D005080:Exercise Test; D006339:Heart Rate; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D017202:Myocardial Ischemia / Q000175:diagnosis*; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon