title: [Predictive value of differential pulse pressure in the diagnosis of silent myocardial ischemia in patients with type-2 diabetes].
abstract: Silent myocardial ischemia occurs more frequently in diabetics. Differential arterial pulse pressure is a valuable predictor of cardiovascular disease. We studied 48 consecutive male patients with type-2 diabetes and no known history of ischemic heart disease. Ambulatory monitoring of arterial pressure was carried out and the presence of silent myocardial ischemia was studied using a protocol that involved: resting ECG, echocardiography, 24-hour Holter ECG, conventional exercise stress testing, and exercise testing with nuclear scanning. Nine patients (19%) had silent myocardial ischemia. Differential pulse pressure had good discriminative ability in identifying the presence of silent ischemia: the area under the receiver operating characteristic (ROC) curve was 0.83 (95% confidence interval [CI], 0.71-0.96; P=.002). This predictive ability was also observed on adjusted logistic regression modeling (odds ratio [OR], 1.24, 95% CI = 1.02-1.49). We found that the OR for the risk of silent ischemia for every 10-mmHg increase in differential pulse pressure was 8.5 (95% CI 1.7-31.2). Age and differential pulse pressure were the only independent predictors of silent myocardial ischemia found in this study.
authors.affiliation: Servicio de Cardiología, Hospital Universitario Dr. Peset, Valencia, Spain. magomar@comv.es
authors.forename: Manuel J
authors.initials: MJ
authors.lastname: Gómez
authors.forename: Ildefonso
authors.initials: I
authors.lastname: Roldán
authors.forename: José L
authors.initials: JL
authors.lastname: Díez
authors.forename: Katherine
authors.initials: K
authors.lastname: García
authors.forename: Darío
authors.initials: D
authors.lastname: Sanmiguel
authors.forename: Antonio
authors.initials: A
authors.lastname: Salvador
authors.forename: Adolfo
authors.initials: A
authors.lastname: Rincón de Arellano
authors.forename: Antonio
authors.initials: A
authors.lastname: Hernández-Mijares
mesh_terms: D018660:Blood Pressure Monitoring, Ambulatory; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011312:Pressure; D011674:Pulse