HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (15) Citing Articles via Google Scholar Google Scholar Articles by Di Carli, M. F. Articles by Hachamovitch, R. Search for Related Content PubMed PubMed Citation Articles by Di Carli, M. F. Articles by Hachamovitch, R.

CLINICAL RESEARCH: DIABETES AND DETECTION OF CAD

Should we screen for occult coronary artery disease among asymptomatic patients with diabetes?

Marcelo F. Di Carli, MD, FACC^*,* and Rory Hachamovitch, MD, MSc, FACC

^{* *}Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
Division of Cardiology, Department of Medicine, University of Southern California, Los Angeles, California

Manuscript received August 3, 2004; revised manuscript received September 17, 2004, accepted September 21, 2004.

^* Reprint requests and correspondence: Dr. Marcelo F. Di Carli, Division of Nuclear Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115 (Email: mdicarli{at}partners.org).

Diabetes mellitus predisposes people to premature atherosclerotic coronary artery disease (CAD). The risk of a myocardial infarction in diabetics without overt evidence of obstructive CAD matches that of patients without diabetes who have had a previous myocardial infarction. The available data suggest that occult CAD is a common finding among asymptomatic diabetics, ranging from 20% to >50%. The diagnostic accuracy of myocardial perfusion single-photon emission computed tomography (SPECT) in diabetics appears to be comparable to that observed in nondiabetic individuals. As shown in other patient groups, the ischemic burden assessed by stress SPECT in subjects with diabetes is also linked to their increased risk of adverse cardiovascular events. Among patients with normal stress SPECT, however, those with diabetes are at significantly greater risk than non-diabetics. Testing diabetics with an abnormal resting electrocardiogram or with evidence of peripheral or carotid occlusive arterial disease appears to result in an excellent yield of abnormal SPECT findings, as does testing in the setting of dyspnea. However, recent evidence suggests that achieving an adequate yield in asymptomatic diabetics without overt evidence of CAD is a greater challenge. Further investigation of sequential testing strategies is needed in order to identify an efficient means for screening asymptomatic patients with diabetes.

Abbreviations and Acronyms   ADA = American Diabetes Association   CAD = coronary artery disease   DIAD = Detection of Ischemia in Asymptomatic Diabetics study   ECG = electrocardiogram   MI = myocardial infarction   SPECT = single-photon emission computed tomography

This article has been cited by other articles:

				E. Roelker Screening for Coronary Artery Disease in Patients With Diabetes Diabetes Spectr, July 1, 2008; 21(3): 166 - 171. [Abstract] [Full Text] [PDF]

				G. A. Diamond and S. Kaul COURAGE Under Fire: On the Management of Stable Coronary Disease J. Am. Coll. Cardiol., October 16, 2007; 50(16): 1604 - 1609. [Abstract] [Full Text] [PDF]

				J. W. Askew, T. D. Miller, D. O. Hodge, and R. J. Gibbons The Value of Myocardial Perfusion Single-Photon Emission Computed Tomography in Screening Asymptomatic Patients With Atrial Fibrillation for Coronary Artery Disease J. Am. Coll. Cardiol., September 11, 2007; 50(11): 1080 - 1085. [Abstract] [Full Text] [PDF]

				P. F. Cohn A new look at benefits of drug therapy in silent myocardial ischaemia Eur. Heart J., September 1, 2007; 28(17): 2053 - 2054. [Full Text] [PDF]

				G. A. Beller Noninvasive Screening for Coronary Atherosclerosis and Silent Ischemia in Asymptomatic Type 2 Diabetic Patients: Is it Appropriate and Cost-Effective? J. Am. Coll. Cardiol., May 15, 2007; 49(19): 1918 - 1923. [Abstract] [Full Text] [PDF]

				Y. S. Ali and D. J. Maron Screening for Coronary Disease in Diabetes: When and How Clin. Diabetes, October 1, 2006; 24(4): 169 - 173. [Abstract] [Full Text] [PDF]

				J. J. Bax and E. E. van der Wall Assessment of coronary artery disease in patients with (a)symptomatic diabetes Eur. Heart J., March 2, 2006; 27(6): 631 - 632. [Full Text] [PDF]

				A. R. Albers, M. Z. Krichavsky, and G. J. Balady Stress Testing in Patients With Diabetes Mellitus: Diagnostic and Prognostic Value Circulation, January 31, 2006; 113(4): 583 - 592. [Full Text] [PDF]

				F. Bursi, L. Babuin, A. Barbieri, L. Politi, M. Zennaro, T. Grimaldi, A. Rumolo, M. Gargiulo, A. Stella, M. G. Modena, et al. Vascular surgery patients: perioperative and long-term risk according to the ACC/AHA guidelines, the additive role of post-operative troponin elevation Eur. Heart J., November 2, 2005; 26(22): 2448 - 2456. [Abstract] [Full Text] [PDF]

				S. Stern Symptoms Other Than Chest Pain May Be Important in the Diagnosis of "Silent Ischemia," or "The Sounds of Silence" Circulation, June 21, 2005; 111(24): e435 - e437. [Full Text] [PDF]