Vol 3, No 1 (2002): Practical Diabetology
Other materials agreed with the Editors
Published online: 2001-12-06
High incidence of silent myocardial ischemia in elderly patients with non insulin-dependent diabetes mellitus
Diabetologia Praktyczna 2002;3(1):17-24.
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
Keywords: silent myocardial ischemiaelderly NIDM patientstreadmill exercise testdipyridamole thallium scintigraphycoronary angiography