Current imaging techniques for evaluation of coronary artery disease in diabetic patients

摘要

Introduction Diabetic patients are at high risk for cardiovascular disease (CVD). It is estimated that 2 out of 3 diabetic patients die from heart disease or stroke. Diabetic patients have a 2-4 fold increased risk of cardiovascular events (1). Diabetes has a risk equal to that of established coronary artery disease (CAD). Prevalence of CAD is as high as 55%. CAD may be more advanced and diffuse at diagnosis. Silent ischemia is common due to autonomic neuropathy. Myocardial infarction (MI) is often a fust manifestation. Prognosis is unfavorable particularly in women (2). Advantages of early diagnosis of CAD in diabetic patients include improved patient compliance to treatment and identification of patients in whom revascularization could prolong survival as compared to lower-risk patients in whom medical management is preferred (3). Indications for stress test by the American Diabetes Association include the presence of cardiac symptoms, abnormal resting ECG, >=2 cardiovascular risk factors, peripheral or carotid vascular disease and in sedentary patients >35 years, planning to exercise (3). Exercise ECG has moderate sensitivity and specificity for detection of CAD, a fair predictive value for coronary events. Application of exercise ECG as a screening tool in type 2 diabetes is limited as the test is often inconclusive (3).