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Vol 3, No 1 (2002): Practical Diabetology
Original articles (translated)
Published online: 2001-12-06
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High incidence of silent myocardial ischemia in elderly patients with non insulin-dependent diabetes mellitus

T. Inoguchi, T. Yamashita, F. Umeda, H. Mihara, O. Nakagaki, K. Takada, T. Kawano, H. Murao, T. Doi, H. Nawata
Diabetologia Praktyczna 2002;3(1):17-24.

open access

Vol 3, No 1 (2002): Practical Diabetology
Original articles (translated)
Published online: 2001-12-06

Abstract

The present study was designed reveal the incidence of silent myocardial ischemia in asymptomatic elderly non-insulin-dependent diabetic (NIDDM) patients (aged over 60 years). As a first step screening, maximal treadmill exercise test was performed. Of 140 patients studied, 54 (38.6%) were unable or not expected to achieve diagnostic levels of exercise during treadmill testing. A positive exercise test was noted in 39 of 86 (45.3%) subjects. As a second step examination, dipyridamole thallium scintigraphy was performed for 93 subjects who exhibited a positive exercise test and could not perform a maximal exercise test. Abnormal perfusion pattern was found in 39 of 93 (41.9%), who were finally considered to have a silent myocardial ischemia. Coronary angiography was performed in 18 subjects with diagnosis of silent myocardial ischemia, who gave their consent. Significant coronary artery stenosis was in fact found in 17 of 18 (94.4%) subjects studied, confirming a very high positive predictive value of this diagnostic procedure. In conclusion, elderly NIDDM patients (aged over 60 years) had an extremely high prevalence (estimated 26.3%) of silent myocardial ischemia. This evidence suggests that early and intensive detection may be needed as a part of routine care for this group

Abstract

The present study was designed reveal the incidence of silent myocardial ischemia in asymptomatic elderly non-insulin-dependent diabetic (NIDDM) patients (aged over 60 years). As a first step screening, maximal treadmill exercise test was performed. Of 140 patients studied, 54 (38.6%) were unable or not expected to achieve diagnostic levels of exercise during treadmill testing. A positive exercise test was noted in 39 of 86 (45.3%) subjects. As a second step examination, dipyridamole thallium scintigraphy was performed for 93 subjects who exhibited a positive exercise test and could not perform a maximal exercise test. Abnormal perfusion pattern was found in 39 of 93 (41.9%), who were finally considered to have a silent myocardial ischemia. Coronary angiography was performed in 18 subjects with diagnosis of silent myocardial ischemia, who gave their consent. Significant coronary artery stenosis was in fact found in 17 of 18 (94.4%) subjects studied, confirming a very high positive predictive value of this diagnostic procedure. In conclusion, elderly NIDDM patients (aged over 60 years) had an extremely high prevalence (estimated 26.3%) of silent myocardial ischemia. This evidence suggests that early and intensive detection may be needed as a part of routine care for this group

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Keywords

silent myocardial ischemia; elderly NIDM patients; treadmill exercise test; dipyridamole thallium scintigraphy; coronary angiography

About this article
Title

High incidence of silent myocardial ischemia in elderly patients with non insulin-dependent diabetes mellitus

Journal

Clinical Diabetology

Issue

Vol 3, No 1 (2002): Practical Diabetology

Pages

17-24

Published online

2001-12-06

Bibliographic record

Diabetologia Praktyczna 2002;3(1):17-24.

Keywords

silent myocardial ischemia
elderly NIDM patients
treadmill exercise test
dipyridamole thallium scintigraphy
coronary angiography

Authors

T. Inoguchi
T. Yamashita
F. Umeda
H. Mihara
O. Nakagaki
K. Takada
T. Kawano
H. Murao
T. Doi
H. Nawata

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