Identification of asymptomatic type 2 diabetes mellitus  patients with a low, intermediate and high risk of ischaemic  heart disease: is there an algorithm?
OBJECTIVE
The leading cause of death in type 2 diabetes is cardiovascular disease (CVD). We examined the prevalence of myocardial ischaemia in type 2 diabetes patients and tried to establish an algorithm to identify patients with a high risk of ischaemic heart disease.


METHODS
Type 2 diabetes patients who had no known or suspected CVD, and had been referred consecutively to a diabetes clinic for the first time (n=305; age 58.6+/-11.3 years; diabetes duration 4.5+/-5.3 years) were screened for myocardial ischaemia using myocardial perfusion scintigraphy (MPS).


RESULTS
The univariate predictors of myocardial ischaemia were: atypical or typical angina pectoris, two or more traditional risk factors for CVD, BMI >32 kg/m2, systolic blood pressure >140 mmHg, HbA1c >8.5%, high-sensitivity C-reactive protein >4.0 mg/l, N-terminal pro-brain natriuretic peptide >300 pg/ml, left atrial volume index >32 ml/m2, left ventricular ejection fraction <50%, and carotid and peripheral arterial disease. The algorithm identified low (n=96), intermediate (n=65) and high risk groups (n=115), in which the prevalence of myocardial ischaemia was 15%,23% and 43%, respectively. Overall the algorithm reduced the number of patients referred to MPS from 305 to 144.However, the sensitivity and specificity of the algorithm was just 68% and 62%, respectively.


CONCLUSIONS
Our algorithm was able to stratify which patients had a low, intermediate or high risk of myocardial ischaemia based on MPS. However, the algorithm had low sensitivity and specificity, combined with high cost and time requirements.


BACKGROUND
clinicaltrials.gov NCT00298844 FUNDING: The study was funded by the Danish Cardio vascular Research Academy (DaCRA), The Danish Diabetes Association and The Danish Heart Foundation.
Poulsen
M K
MK
Department of Endocrinology, Odense University Hospital, Kløvervaenget 6, 5th floor, 5000 Odense C, Denmark. doc_mkp@hotmail.com.dk
Henriksen
J E
JE
Vach
W
W
Dahl
J
J
Møller
J E
JE
Johansen
A
A
Gerke
O
O
Haghfelt
T
T
Høilund-Carlsen
P F
PF
Beck-Nielsen
H
H
D000465:Algorithms; D000787:Angina Pectoris / Q000209:etiology; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002648:Child; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis*; D003925:Diabetic Angiopathies / Q000150:complications / Q000453:epidemiology*; D004452:Echocardiography; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006973:Hypertension / Q000150:complications; D017202:Myocardial Ischemia / Q000453:epidemiology*; D050177:Overweight / Q000150:complications; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D014463:Ultrasonography
D002097:C-Reactive Protein; D006442:Glycated Hemoglobin