| Detecting silent coronary stenoses and stratifying cardiac risk in patients with diabetes: ECG stress test or exercise myocardial scintigraphy? | |
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MedLine Citation:
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PMID: 15049936 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIMS: To determine whether performing a myocardial scintigraphy immediately after a maximal electrocardiogram (ECG) stress test is effective in detecting silent coronary stenoses and predicting cardiovascular events. METHODS: Asymptomatic patients (n = 262) aged 57.6 +/- 8.8 years, with diabetes for 12.0 years (5-39) [median (range)] and no history of a cardiac event, underwent a maximal ECG stress test followed by a myocardial scintigraphy. The patients with an abnormal ECG stress test or abnormal imaging underwent a coronary angiography. Cardiac events were assessed in 250 (95.4%) patients followed for 37.8 months (3-101). RESULTS: The ECG stress test was abnormal in 54 patients. Among them, 18 had coronary stenoses and seven had a cardiac event. Despite a normal ECG stress test, the myocardial scintigraphy was abnormal in 42 additional patients, including 16 patients with coronary stenoses. Four of these 42 patients experienced a cardiac event. Follow-up showed a poor prognosis in subjects who were abnormal on the two tests. Univariate predictors of the 15 cardiac events were the ECG stress test [odds ratio (OR) 3.9, 95% confidence interval (CI) 1.3, 11.4, P = 0.008], myocardial scintigraphy (OR 3.8, 95% CI 1.3, 11.0, P = 0.009), coronary stenoses (OR 26.6, 95% CI 7.6, 90.7, P < 0.001), and peripheral or carotid occlusive arterial disease (OR 9.5, 95% CI 2.1, 42.5, P < 0.001). CONCLUSIONS: In the asymptomatic patients with diabetes, combining a myocardial scintigraphy with a maximal ECG stress test is effective in detecting more patients with coronary stenoses and predicting cardiovascular events. However, the ECG stress test has a good negative predictive value for cardiac events (97%), is cheaper, and should therefore be proposed first. |
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Authors:
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E Cosson; F Paycha; J Paries; S Cattan; A Ramadan; D Meddah; J-R Attali; P Valensi |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Diabetic medicine : a journal of the British Diabetic Association Volume: 21 ISSN: 0742-3071 ISO Abbreviation: Diabet. Med. Publication Date: 2004 Apr |
Date Detail:
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Created Date: 2004-03-30 Completed Date: 2004-06-30 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 8500858 Medline TA: Diabet Med Country: England |
Other Details:
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Languages: eng Pagination: 342-8 Citation Subset: IM |
Affiliation:
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Department of Endocrinology-Diabetology-Nutrition, AP-HP, Paris-Nord University, Jean Verdier Hospital, Bondy, France. emmanuel.cosson@jvr.ap-hop-paris.fr |
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| MeSH Terms | |
Descriptor/Qualifier:
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Cardiovascular Diseases
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diagnosis Cohort Studies Coronary Angiography Coronary Stenosis / diagnosis*, radionuclide imaging Diabetic Angiopathies / diagnosis*, radionuclide imaging Electrocardiography Exercise Test Female Heart / radionuclide imaging* Humans Male Middle Aged Myocardial Ischemia / diagnosis, radionuclide imaging Predictive Value of Tests Prognosis Prospective Studies Risk Factors |
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