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© 2005 by the American Diabetes Association, Inc.
Reviews/Commentaries/ADA Statements |
Ischemia Imaging and Plaque Imaging in Diabetes
Complementary tools to improve cardiovascular risk management
1 Section of Cardiology, Tulane University School of Medicine, Tulane University, New Orleans, Louisiana
2 Division of Nephrology, Ospedale San Paolo, Universita’ di Milano, Milan, Italy
3 Division of Cardiology, Universita’ di Modena e Reggio Emilia, Modena, Italy
Address correspondence and reprint requests to Paolo Raggi, MD, Tulane University School of Medicine, Tulane University, 1430 Tulane Ave., SL-48, New Orleans, LA 70112. E-mail: praggi{at}tulane.edu
Cardiovascular disease is the most frequent cause of death and disability in diabetes, and the morbidity and mortality for coronary artery disease (CAD) in this population is two to four times higher than in nondiabetic subjects. Traditional risk factors do not fully explain the level of cardiovascular risk, and coronary disease events are often silent in diabetic patients. Thus, research has recently focused on improving the risk assessment of an individual patient with new tools in an effort to better identify subjects at highest risk and in need of aggressive management. Cardiovascular imaging has proven very helpful in this regard. Traditional methods to assess CAD are based on detection of obstructive luminal disease responsible for myocardial ischemia. However, acute coronary syndromes often occur in the absence of luminal stenoses. Hence, the utilization of imaging methodologies to visualize atherosclerosis in its presymptomatic stages has received mounting attention in recent years. In this article, we review the current literature on the utility of traditional imaging modalities for obstructive CAD (nuclear and echocardiographic stress testing) as well as atherosclerosis plaque imaging with carotid intima-media thickness and coronary artery calcium for risk stratification of diabetic patients.
Abbreviations: CAC, coronary artery calcium • CAD, coronary artery disease • CCS, coronary calcium score • CIMT, carotid intima-media thickness • CT, computed tomography • DSE, dobutamine stress echocardiography • MPI, myocardial perfusion imaging • SE, stress echocardiography
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