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Diabetes Care 27:1745-1747, 2004
© 2004 by the American Diabetes Association, Inc.

Brief Report

Risk Factors for Silent Myocardial Ischemia in High-Risk Type 1 Diabetic Patients

Ariane Sultan, MD1, Christophe Piot, MD2, Denis Mariano-Goulart, MD3, Manase Rasamisoa, MD1, Eric Renard, MD4 and Antoine Avignon, MD1

1 Metabolic Diseases Department, Montpellier University Hospital, Montpellier, France
2 Cardiovascular Diseases Department, Montpellier University Hospital, Montpellier, France
3 Nuclear Medicine Department, Montpellier University Hospital, Montpellier, France
4 Endocrinology Department, Montpellier University Hospital, Montpellier, France

Address correspondence and reprint requests to Antoine Avignon, Metabolic Diseases Department, Lapeyronie Hospital, 371 Ave. Doyen G. Giraud, 34295 Montpellier, Cedex 5, France. E-mail: a-avignon@chu-montpellier.fr

Abbreviations: CAD, coronary artery disease • CAS, coronary artery stenosis • MPI, myocardial perfusion imaging • PAD, peripheral arterial disease • SMI, silent myocardial ischemia

The first 20% of the full text of this article appears below.


   INTRODUCTION
 
Coronary artery disease (CAD) is the leading cause of mortality in people with type 1 diabetes. Silent myocardial ischemia (SMI) is common in this population (1), and a large body of evidence attests to the high diagnostic yield of stress myocardial perfusion imaging (MPI) for the prediction of major coronary events (2,3). However, screening all patients with stress MPI is not practical and should be limited to those with a high-risk profile (4). No such profile has been determined in type 1 diabetic patients.

We thus evaluated the clinical and biological variables associated with silent coronary stenosis to determine a high-risk profile of asymptomatic type 1 diabetic patients who should benefit from stress MPI screening.


   RESEARCH DESIGN AND METHODS
 
All asymptomatic type 1 diabetic patients admitted to our department between January 1999 and June 2002 were considered for SMI screening, using dipyridamol (0.75 mg/kg) combined with exercise on an ergometer bicycle (when feasible) and stress-gated single-photon emission computed tomographic99Tcm-MIBI imaging if they had at least one of the following conditions: one other major cardiovascular risk factors, age ≥60 years, or peripheral arterial disease (PAD). Patients with known CAD, age ≥80 or <30 years, and dipyridamole contraindications were excluded. Participants were considered to have type 1 diabetes if they had a history of ketosis and . . . [Full Text of this Article]


   RESULTS
 

   CONCLUSIONS
 

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Copyright © 2004 by the American Diabetes Association.