Screening of asymptomatic patients with type 2 diabetes mellitus for silent coronary artery disease: combined use of stress myocardial perfusion imaging and coronary calcium scoring.

Diabetes mellitus and coronary artery disease constitute an ominous clinical combination. Rates of morbidity and mortality as a result of cardiovascular complications are high in patients with type 2 diabetes mellitus. Screening for silent coronary artery disease, to detect the disease in an early stage and to be able to initiate early appropriate treatment, has recently become an important focus of clinical investigation. Recent prospective studies have shown that the overall prevalence of silent coronary artery disease in truly asymptomatic individuals with diabetes is about 20% to 25%. It is of practical and clinical importance to explore ways to "enrich" the target screening population. In this editorial point of view the relative roles of stress radionuclide myocardial perfusion imaging and coronary calcium scoring are examined. The two methodologies appear to have complementary values for the screening of asymptomatic individuals with diabetes mellitus. A screening algorithm involving sequential use of coronary calcium scoring and subsequent stress radionuclide myocardial perfusion imaging is proposed.