Saula Vigili de Kreutzenberg1, Anna Solini2, Edoardo Vitolo2, Alessandra Boi3, Simonetta Bacci4, Sara Cocozza5, Rossella Nappo5, Angela Rivellese5, Angelo Avogaro6, Marco Giorgio Baroni7. 1. Endocrinology and Metabolic Diseases, Department of Medicine - DIMED, University of Padova, Italy. Electronic address: saula.dekreutzenberg@unipd.it. 2. Section of Internal Medicine I, University of Pisa, Italy. 3. Endocrinology and Diabetes, Department of Medical Sciences, University of Cagliari, Italy. 4. Casa Sollievo della Sofferenza Hospital, S. Giovanni Rotondo (FO), Italy. 5. Department of Clinical Medicine and Surgery, Federico II University, Napoli, Italy. 6. Endocrinology and Metabolic Diseases, Department of Medicine - DIMED, University of Padova, Italy. 7. Endocrinology, Department Experimental Medicine, Sapienza University of Rome, and IRCCS Neuromed, Pozzilli (IS), Italy.
Abstract
AIMS: The cost-effectiveness of screening for silent coronary heart disease (CHD) in type 2 diabetes (DM2) is still debated. METHODS: We applied a diagnostic algorithm for silent CHD detection, in a cohort of 102 asymptomatic DM2 subjects (57±7years), attending 5 Italian outpatient clinics, to verify its predictive value. The risk of silent CHD was calculated considering classical risk factors, and presence of microangiopathy/macroangiopathy. Patients were divided in 3 groups, i.e. group 1: normal ECG and low silent CHD risk; group 2: abnormal ECG, irrespective of silent CHD risk; group 3: high silent CHD risk, irrespective of ECG. To group 2 and 3, a functional test was recommended and performed in 78% of patients. RESULTS: Silent CHD prevalence was similar in group 2 and 3 (25 vs. 17% respectively; p=0.495). However, evaluating the entire cohort, a significant higher prevalence of silent CHD was observed in subjects with abnormal vs. normal ECG (23 vs. 4%; P=0.004), but not in subjects with high vs. low pre-test silent CHD risk (14 vs. 9%; p=0.472). CONCLUSIONS: An abnormal ECG was a strong, independent predictor of silent CHD (OR 8.9; CI 1.27-62.5; p=0.028) in DM2. Therefore, a functional stress testing should be considered in DM2 patients with ECG abnormalities.
AIMS: The cost-effectiveness of screening for silent coronary heart disease (CHD) in type 2 diabetes (DM2) is still debated. METHODS: We applied a diagnostic algorithm for silent CHD detection, in a cohort of 102 asymptomatic DM2 subjects (57±7years), attending 5 Italian outpatient clinics, to verify its predictive value. The risk of silent CHD was calculated considering classical risk factors, and presence of microangiopathy/macroangiopathy. Patients were divided in 3 groups, i.e. group 1: normal ECG and low silent CHD risk; group 2: abnormal ECG, irrespective of silent CHD risk; group 3: high silent CHD risk, irrespective of ECG. To group 2 and 3, a functional test was recommended and performed in 78% of patients. RESULTS: Silent CHD prevalence was similar in group 2 and 3 (25 vs. 17% respectively; p=0.495). However, evaluating the entire cohort, a significant higher prevalence of silent CHD was observed in subjects with abnormal vs. normal ECG (23 vs. 4%; P=0.004), but not in subjects with high vs. low pre-test silent CHD risk (14 vs. 9%; p=0.472). CONCLUSIONS: An abnormal ECG was a strong, independent predictor of silent CHD (OR 8.9; CI 1.27-62.5; p=0.028) in DM2. Therefore, a functional stress testing should be considered in DM2patients with ECG abnormalities.
Authors: Shannon L Gillespie; Cindy M Anderson; Songzhu Zhao; Yubo Tan; David Kline; Guy Brock; James Odei; Emily O'Brien; Mario Sims; Sophie A Lazarus; Darryl B Hood; Karen Patricia Williams; Joshua J Joseph Journal: Psychoneuroendocrinology Date: 2019-07-04 Impact factor: 4.905
Authors: Young Choi; Yeoree Yang; Byung-Hee Hwang; Eun Young Lee; Kun Ho Yoon; Kiyuk Chang; Farouc A Jaffer; Jae-Hyoung Cho Journal: Clin Cardiol Date: 2020-07-13 Impact factor: 2.882