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.
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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 |
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