Which coronary investigations in asymptomatic diabetics

Coronary artery disease is a common, serious and insidious complication of diabetes. Myocardial ischaemia is often silent. All diabetics do not have t he same coronary risk and, therefore, it is important to determine which in vestigations to perform and which patients. This strategy is justified because it allows identification of these cases which require a medical or an invasive (angioplasty, surgical revascularisa tion) approach, as these interventions may improve the prognosis. The first stage is clinical (investigation of cardiovascular risk factors). When mor e than two risk factors are found, further investigations are justified. Exercise stress testing provide reassuring diagnostic and prognostic data w hen maximal and negative. When sub-maximal, impossible or significantly isc haemic, a second investigation is useful. Holter ECG recording with analysi s of ST Variation lacks sensitivity and, above all, specificity. The diagno stic value of perfusion myocardial scintigraphy in the diabetic is not as g ood as that observed in the general population, but its prognostic value re mains good. Ischaemia involving over 20 % of the myocardium justifies thera peutic investigation. Stress echocardiography has been validated in the dia gnosis and prognosis of coronary artery disease and its sensitivity and spe cificity are probably the same as those of scintigraphy. The authors conclude that the asymptomatic diabetic requires clinical and s taged paraclinical investigation to assess prognosis and, depending on the results, the adoption of a beneficial therapeutic strategy.