Diabetic patients are at greater risk of cardiovascular disease than non-diabetic individuals, coronary artery disease (CAD) has a less favourable prognosis and is more likely to be silent in diabetic than in non-diabetic patients. Thus, screening is an integral component of risk-reduction strategies for such patients. The available non-invasive testing options include exercise tolerance testing (ETT), stress echocardiography, and stress myocardial perfusion imaging (MPI) with or without gated single-photon emission computed tomography (SPECT). Calcium scoring with electron beam computed tomography (EBCT) and magnetic resonance imaging (MRI) are promising techniques, requiring further validation. Stress MPI with gated SPECT enables assessment of myocardial ischaemia, viability, and function, and allows for risk stratification to improve clinical management in diabetic patients.
Murray JL, Lopez ADThe global burden of disease. World Health Organization , Geneva, 1996.
2.
Rayner M., Petersen S., Buckley C., Press V.Coronary heart disease statistics: diabetes supplement. British Heart Foundation, 2001.
3.
American Diabetes Association.Consensus Development Conference on the diagnosis of coronary heart disease in people with diabetes. 10-11 February 1998, Miami, Florida. Diabetes Care1998;21:1551-9.
4.
Miettinen H. , Lehto S., Salomaa V. et al. Impact of diabetes on mortality after the first myocardial infarction. The FINMONICA Myocardial Infarction Register Study Group. Diabetes Care1998;21:69-75.
5.
Haffner SM, Lehto S., Ronnemaa T. et al. Mortality from coronary heart disease in subjects with type 2 diabetes and in non-diabetic subjects with and without prior myocardial infarction. N Engl J Med1998;339:229-34.
6.
Evans JMM , Wang J., Morris ADComparison of cardiovascular risk between patients with type 2 diabetes and those who had had a myocardial infarction: cross sectional and cohort studies . BMJ2002 ;324:939-43.
7.
Jacoby RM, Nesto RWAcute myocardial infarction in the diabetic patient: pathophysiology, clinical course and prognosis. J Am Coll Cardiol1992 ;20:736-44.
8.
Koistinen MJPrevalence of asymptomatic myocardial ischaemia in diabetic subjects. BMJ1990;301:92-5.
9.
Cooper S., Caldwell JHCoronary artery disease in people with diabetes: diagnostic and risk factor evaluation. Clin Diabetes1999;17:58-70.
10.
Janand-Dellene B., Savin B., Habib G. et al. Silent myocardial ischemia in patients with diabetes. Diabetes Care1999;22:1396-400.
11.
International Diabetes Federation.Diabetes Atlas2003. http://www.idf.org/e-atlas
12.
Starkman HS , Cable G., Hala V., Hecht H., Donnelly CMDelineation of prevalence and risk factors for early coronary artery disease by electron beam computed tomography in young adults with type I diabetes. Diabetes Care2003;26:433-6.
13.
Elkeles R., Flather M., Feher MD et al. Prospective evaluation of diabetic ischaemic heart disease by computed tomography: PREDICT study. Br J Diabetes Vasc Dis2002;2:69-72.
14.
Mielke C., Shields J., Broemeling L.Coronary artery calcium, coronary artery disease, and diabetes. Diabetes Res Clin Pract2001;53:55-61.
15.
O'Rourke RA , Brundage BH, Froehlicher VF et al. American College of Cardiology/American Heart Association expert consensus document in electron beam computed tomography for the diagnosis and prognosis of coronary artery disease. Circulation2000;102:126-40.
16.
Task Force of the European Society of Cardiology in collaboration with the Association of European Paediatric Cardiologists.The clinical role of magnetic resonance in cardiovascular disease. Eur Heart J1998;19:19-39.
17.
American Diabetes Association.Standards of medical care for patients with diabetes mellitus. Diabetes Care2002 ;25:S33-S49.
18.
Vanzetto G. , Halimi S., Hammoud T. et al. Prediction of cardiovascular events in clinically selected high-risk NIDDM patients. Prognostic value of exercise stress test and thallium-201 single-photon emission computed tomography. Diabetes Care1999;22:19-26.
19.
Gibbons RJ, Balady GJ, Mark DB et al. ACC/AHA 2002 guideline update for exercise testing. A report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). Circulation2002;106:1-60.
20.
Inzucchi SENoninvasive assessment of the diabetic patient for coronary artery disease. Diabetes Care2001;24:1519-21.
21.
Gianrossi R. , Detrano R., Colombo A. et al. Exercise-induced ST depression in the diagnosis of coronary artery disease: a meta-analysis . Circulation1989;80:87-98.
22.
Cheitlin MD , Armstrong WF, Aurigemma GP et al. ACC/AHA/ASE 2003 guideline update of the clinical application of echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to update the 1997 guidelines for the clinical application of echocardiography). Circulation2003;108:1-90.
23.
Fleischmann KE, Hunink MG, Kuntz KM, Douglas PSExercise echocardiography or exercise SPECT imaging? A meta-analysis of diagnostic test performance . JAMA1998;280:913-20.
24.
Bigi R., Desideri A., Cortigiani L. et al. Stress echocardiography for risk stratification of diabetic patients with known or suspected coronary artery disease. Diabetes Care2001;24:1596-601.
25.
Leischik R. , Kuhlman C., Bruch C. et al. Reproducibility of stress echocardiography using intravenous injection of ultrasound contrast agent (BY 963). Int J Card Imaging1997;13:387-94.
26.
Hung MJ, Wang CH, Cherng WJCan dobutamine stress echocardiography predict cardiac events in nonrevascularized diabetic patients following acute myocardial infarction?Chest1999;116:1224-32.
27.
Hennessy TG , Codd MB, Kane G. et al. Evaluation of patients with diabetes mellitus for coronary artery disease using dobutamine stress echocardiography . Coron Artery Dis1997;8:171-4.
28.
Klocke FJ, Baird MG, Lorell BH et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging - Executive Summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (ACC/AHA/ASNC Committee to revise the 1995 guidelines for the clinical use of cardiac radionuclide imaging). Circulation2003;108:1404-18.
29.
Leppo JAComparison of pharmacologic stress agents. J Nucl Cardiol1996;3:S22-S26.
30.
Heller GV, Shehata ARPharmacological stress testing with technetium-99m single-photon emission computerized tomography imaging in the preoperative assessment of patients undergoing noncardiac surgery. Am J Card Imaging1997;10:120-7.
31.
Beller GA, Zaret BLContributions of nuclear cardiology to diagnosis and prognosis of patients with coronary artery disease. Circulation2000; 101:1465-78.
32.
Giri S., Shaw LJ, Murthy DR et al. Impact of diabetes on the risk stratification using stress single-photon emission computed tomography myocardial perfusion imaging in patients with symptoms suggestive of coronary artery disease. Circulation2002;105:32-40.
33.
Hachamovitch R., Shaw LJ, Berman DSThe ongoing evaluation of risk stratification using myocardial perfusion imaging in patients with known or suspected coronary disease. ACC Curr J Rev1999;8:66-71.
34.
Iskander S., Iskandrian AERisk assessment using single-photon emission computed tomographic technetium-99m sestamibi imaging. J Am Coll Cardiol1998;32:57-62.
35.
Taillefer R. , DePuey EG, Udelson JE et al. Comparative diagnostic accuracy of Tl-201 and Tc-99m sestamibi SPECT imaging (perfusion and ECGgated SPECT) in detecting coronary artery disease in women. J Am Coll Cardiol1997;29:69-77.
36.
Sharir T., Germano G., Kavanagh PB et al. Incremental prognostic value of post-stress left ventricular ejection fraction and volume by gated myocardial perfusion single photon emission computed tomography. Circulation1999;100:1035-42.
37.
Danias PG, Ahlberg AW, Clark BA 3rd et al. Combined assessment of myocardial perfusion and left ventricular function with exercise technetium-99m sestamibi gated single-photon emission computed tomography can differentiate between ischemic and nonischemic dilated cardiomyopathy. Am J Cardiol1998;82:1253-8.
38.
Shaw LJ, Hachamovitch R., Heller GV et al. Noninvasive strategies for the estimation of cardiac risk in stable chest pain patients. Am J Cardiol2000 ;86:1-7.
39.
Kang X., Berman DS, Lewin HC et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography in patients with diabetes mellitus. Am Heart J1999;138:1025-32.
40.
Kang X., Berman DS, Lewin H. et al. Comparative ability of myocardial perfusion single-photon emission computed tomography to detect coronary artery disease in patients with and without diabetes mellitus. Am Heart J1999 ;137:949-57.
41.
Lewin HC, Berman DS, Shaw LJ et al. Noninvasive risk assessment of diabetic and nondiabetic patients with suspected ischemic heart disease. J Am Coll Cardiol1999;33:447A.
42.
Miller TD, Rajagopalan N., Hodge DO et al. The yield of screening stress myocardial perfusion imaging in asymptomatic diabetics. J Am Coll Cardiol2002;39:163A.
43.
Greenland P. , LaBree L., Azen SP, Doherty TM, Detrano RCCoronary artery calcium score combined with Framingham Score for risk prediction in asymptomatic individuals. JAMA2004;291:210-15.
44.
Wackers FJ, Young LH, Inzucchi SE et al. Detection of myocardial ischemia in asymptomatic diabetic subjects: the DIAD study. Diabetes Care2004, 27:1954-61.
45.
De Backer G. , Ambrosioni E., Borch-Johnsen K. et al. European guidelines on cardiovascular disease prevention in clinical practice. Executive summary . Eur Heart J2003;24:1601-10.
