Inducible myocardial ischaemia in asymptomatic Type 2 diabetic patients

Background: to define the prevalence of inducible myocardial ischaemia in a symptomatic Type 2 diabetic patients and its relation to urinary albumin ex cretion rate (AER). Methods: 98 Type 2 diabetic patients aged 56 +/- 7 year s, and 20 non-diabetic volunteers were recruited. Dypiridamole plus exercis e thallium-201 myocardial single photon emission computed tomography (SPECT ) was performed in all participants. Exclusion criteria were: age < 30 or > 70 years, evidence of cardiovascular disease, anomalous EGG, autonomic neu ropathy or serum creatinine level > 177 mu mol/l. Results: 36; out of 98 di abetic patients (37%) showed abnormal thallium SPECT (considered as inducib le myocardial ischaemia), versus one out of 20 (5%) in control group (odds ratio 7.3 (95% CI 1.1-50.5), P < 0.005). Among diabetic patients, prevalenc e of inducible ischaemia was greater in those with higher urinary AER (AER < 30:30-300: > 300 mg/24 h: 26: 53: 88%, and greater ill the normoalbuminur ic group compared to the control group (36 vs. 5%; P < 0.05). An AER > 30 m g/24 h was the only independent factor associated with inducible myocardial ischaemia in the multivariate analysis (P = 0.009). Conclusions: raised ur inary AER in asymptomatic diabetic patients is a risk factor for present my ocardial ischaemia demonstrated by thallium dypiridamole tomography. The pr evalence of inducible myocardial ischaemia in asymptomatic diabetic patient s without known coronary disease is much higher than in non-diabetic popula tion. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.