OBJECTIVE. Long history of diabetes and persistant positive microalbuminuria significantly increase the risk of cardio-vascular complications. Detection of patients with vascular changes before their clinical manifestation with the use of sensitive and specific diagnostic procedures might lead to decrease in early mortality from coronary heart disease in this group of patients. AIM OF STUDY. Was to evaluate the coronary blood flow with the use of single photon emission computer tomography (SPECT) in young patients, with diabetic history longer than 5 years, negative towards circulatory diseases, negative ECG exercise test, negative or persistant positive microalbuminuria.
RESEARCH DESING. The study was entered by 8 patients with positive microalbuminuria (5 female, 3 male; aged 26,8 ± 4,7 years, diabetic history 15,8 ± ± 4,9 years and HbA1C 8,3 ± 2,3%) and 12 patients with negative microalbuminuria (9 female, 3 male; aged 26,4 ± 6,7 years, diabetic history 13,0 ± 3,9 years and HbA1C 8,8 ± 1,8%).
MATERIAL AND METHODS. Myocardial perfusion was examined by single photon emission computer tomography (SPECT) with gamma-camera (Siemens) with the system ICON 6.0.3. The study was performed at rest and during ischaemia induced pharmacologically with dipiridamol (0.56 mg/kg body weight). We used MIBI (methoxy-isobutyl-isonitrile) marked with 99mTc in dose 2 x 20 mCi. Selected parameters of heart rate variability (SNN50, SDNN, RMSSD, trianale index) were also compared. RESULTS. In the SPECT analysis we observed significant changes in radioactivity after dipiridamol in 6 patients with positive microalbuminuria (75,0%) and in 2 patients without microalbuminuria (17,0%). The assessed parameters of heart rate variability did not show any significant differences (p > 0,05). Myocardial perfusion changes coexisted with diabetic retinopathy in 88% patients with positive microalbuminuria and in 100% with negative microalbuminuria.
CONCLUSIONS.
1. Most patients with type 1 diabetes and positive microalbuminuria show significant, yet asymptomatic changes in myocardial blood flow.
2. Microalbuminuria appears as good early indicator of coronary heart disease in diabetic patients.
3. Diabetic retinopathy suggests presence changes of myocardial perfusion.
4. Patients with type 1 diabetic history longer than 5 years and microangipathy need an earlier and precise cardiological assessment