title: Transthoracic echocardiographic abnormalities in asymptomatic diabetic patients: association with microalbuminuria and silent coronary artery disease.
abstract: OBJECTIVE
  This study aimed to assess, on routine echocardiography, cardiac left ventricular (LV) disorders, their determinants and their role in the screening process of silent myocardial ischaemia (SMI) in asymptomatic diabetic patients.
  
  
  METHODS
  A total of 586 asymptomatic diabetic patients with one or more additional cardiovascular risk factors, but no history of heart failure or myocardial infarction, prospectively underwent rest echocardiography and myocardial scintigraphy. Those with SMI (abnormal scintigraphy) were subsequently screened for angiographic coronary artery disease (CAD).
  
  
  RESULTS
  LV hypertrophy, LV dilatation, systolic dysfunction and hypokinesia were found in 33.6, 8.6, 3.2 and 6.1%, respectively, of the study population. SMI was found in 156 (26.6%) patients, 55 of whom had silent CAD. On multivariate analysis, age (OR: 1.03 [1.00-1.05], P=0.02), microalbuminuria (OR: 2.2 [1.4-3.2], P<0.0001) and silent CAD (OR: 2.4 [1.3-4.6], P=0.007) were predictive of LV hypertrophy. Creatinine clearance (OR: 0.97 [0.96-0.99], P=0.002) and silent CAD (OR: 3.7 [1.3-10.0]) were associated with LV dilatation. LV systolic dysfunction was associated with microalbuminuria (OR: 3.8 [1.3-11.4], P=0.02) and silent CAD (OR: 3.8 [1.1-12.6], P=0.03). Hypokinesia was associated with retinopathy (OR: 2.4 [1.1-5.4], P=0.04), microalbuminuria (OR: 2.3 [1.1-5.0], P=0.04) and LV dilatation (OR: 3.0 [1.1-8.1], P=0.03). In patients with SMI, the positive predictive value of LV hypertrophy associated with another echocardiographic abnormality (n=19) for CAD was 63.2%.
  
  
  CONCLUSIONS
  LV hypertrophy was found in one-third of asymptomatic diabetic patients, while LV dilatation, systolic dysfunction or hypokinesia was seen in<10%. The main predictors of LV abnormalities were microalbuminuria and silent CAD. The presence of LV hypertrophy with another abnormality should raise the possibility of the presence of silent CAD.
authors.affiliation: Département d'Endocrinologie-Diabétologie-Nutrition, AP-HP, Jean-Verdier Hospital, Université Paris 13, CRNH-IdF, Bondy, France.
authors.forename: M T
authors.initials: MT
authors.lastname: Nguyen
authors.forename: E
authors.initials: E
authors.lastname: Cosson
authors.forename: P
authors.initials: P
authors.lastname: Valensi
authors.forename: P
authors.initials: P
authors.lastname: Poignard
authors.forename: A
authors.initials: A
authors.lastname: Nitenberg
authors.forename: I
authors.initials: I
authors.lastname: Pham
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D058070:Asymptomatic Diseases; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology; D048909:Diabetes Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000097:blood / Q000000981:diagnostic imaging* / Q000453:epidemiology; D004452:Echocardiography; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D012372:ROC Curve; D006113:United Kingdom / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000453:epidemiology