Document Detail


Stress myocardial scintigraphy and dobutamine echocardiography in the detection of coronary disease in asymptomatic patients with type 2 diabetes.
MedLine Citation:
PMID:  15959419     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The aims of this prospective study were: (1) to compare stress thallium-201 single photon emission computed tomography (SPECT) and dobutamine echocardiography (DE) in the detection of silent myocardial ischemia (SMI) in asymptomatic high risk diabetic patients; (2) to analyse long-term outcome after intensive care of SMI in these patients. METHODS: SPECT was performed in 100 high risk diabetic patients and DE in the first 75 patients. Coronary angiography was realized in patients with SMI, with revascularization for suitable lesions. Intensive treatment of atherosclerosis risk factors was performed in all patients. Patients were followed 2 +/- 0.5 years for the subsequent occurrence of cardiac death, myocardial infarction and revascularization. RESULTS: SMI was detected by SPECT in 62% and by DE in 10% of the patients (p < 0.0001), whereas significant coronary stenosis at angiography was detected by SPECT in 26% and by DE in 5% of the patients (p < 0.02). Independent predictive factors of significant coronary stenosis were male gender (p < 0.03) and peripheral arterial disease (p < 0.007). Nonfatal acute coronary syndrome occurred during follow-up in 2 patients (2%). Subsequent revascularization procedure was needed in 9 patients. Baseline patients' characteristics, as well as SMI, were not predictive of cardiac event during follow up. CONCLUSION: SPECT seems more accurate than DE to detect significant coronary stenosis in high risk asymptomatic diabetic patients. In this population, aggressive treatment of SMI with systematic revascularization combined with intensive care of risk factors is associated with a favorable long-term prognosis, similar in diabetic patients with and without initial SMI.
Authors:
Cl L Le Feuvre; O Barthélémy; D Dubois-Laforgue; Ch Maunoury; A Mogenet; N Baubion; J P Metzger; J Timsit
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Diabetes & metabolism     Volume:  31     ISSN:  1262-3636     ISO Abbreviation:  Diabetes Metab.     Publication Date:  2005 Apr 
Date Detail:
Created Date:  2005-06-16     Completed Date:  2005-09-26     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9607599     Medline TA:  Diabetes Metab     Country:  France    
Other Details:
Languages:  eng     Pagination:  135-42     Citation Subset:  IM    
Affiliation:
Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, France. claude.lefeuvre@psl.ap-hop-paris.fr
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Agonists / diagnostic use*
Blood Pressure
Body Mass Index
Coronary Angiography
Coronary Disease / radionuclide imaging*,  ultrasonography*
Diabetes Mellitus, Type 2 / complications
Diabetic Angiopathies / radionuclide imaging*,  ultrasonography*
Dobutamine / diagnostic use*
Echocardiography / methods
Exercise Test / methods*
Female
Humans
Male
Middle Aged
Reproducibility of Results
Sensitivity and Specificity
Thallium Radioisotopes / diagnostic use
Tomography, Emission-Computed, Single-Photon
Ultrasonography, Doppler
Chemical
Reg. No./Substance:
0/Adrenergic beta-Agonists; 0/Thallium Radioisotopes; 34368-04-2/Dobutamine

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