Cited by 791Cardiac Imaging and DiagnosticsCardiovascular Function and Risk FactorsDiabetes, Cardiovascular Risks, and Lipoproteins

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Detection of Silent Myocardial Ischemia in Asymptomatic Diabetic Subjects

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Wackers, Frans J.Th., Young, Lawrence H., Inzucchi, Silvio E., Chyun, Deborah A., Davey, Janice A., Barrett, Eugene J., Taillefer, Raymond, Wittlin, Steven D., Heller, Gary V., Filipchuk, Neil, Engel, Samuel, Ratner, Robert E., Iskandrian, Ami E., for the Detection of Ischemia in Asymptomatic Diabetics (DIAD) Investigators·2004·Diabetes Care

DOI 10.2337/diacare.27.8.1954

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Abstract

OBJECTIVE—To assess the prevalence and clinical predictors of silent myocardial ischemia in asymptomatic patients with type 2 diabetes and to test the effectiveness of current American Diabetes Association screening guidelines. RESEARCH DESIGN AND METHODS—In the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study, 1,123 patients with type 2 diabetes, aged 50–75 years, with no known or suspected coronary artery disease, were randomly assigned to either stress testing and 5-year clinical follow-up or to follow-up only. The prevalence of ischemia in 522 patients randomized to stress testing was assessed by adenosine technetium-99m sestamibi single-photon emission–computed tomography myocardial perfusion imaging. RESULTS—A total of 113 patients (22%) had silent ischemia, including 83 with regional myocardial perfusion abnormalities and 30 with normal perfusion but other abnormalities (i.e., adenosine-induced ST-segment depression, ventricular dilation, or rest ventricular dysfunction). Moderate or large perfusion defects were present in 33 patients. The strongest predictors for abnormal tests were abnormal Valsalva (odds ratio [OR] 5.6), male sex (2.5), and diabetes duration (5.2). Other traditional cardiac risk factors or inflammatory and prothrombotic markers were not predictive. Ischemic adenosine-induced ST-segment depression with normal perfusion (n = 21) was associated with women (OR 3.4). Selecting only patients who met American Diabetes Association guidelines would have failed to identify 41% of patients with silent ischemia. CONCLUSIONS—Silent myocardial ischemia occurs in greater than one in five asymptomatic patients with type 2 diabetes. Traditional and emerging cardiac risk factors were not associated with abnormal stress tests, although cardiac autonomic dysfunction was a strong predictor of ischemia.

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Authors: Wackers, F. J. T., Young, L. H., Inzucchi, S. E., Chyun, D. A., Davey, J. A., Barrett, E. J., Taillefer, R., Wittlin, S. D., Heller, G. V., Filipchuk, N., Engel, S., Ratner, R. E., Iskandrian, A. E., & for the Detection of Ischemia in Asymptomatic Diabetics (DIAD) Investigators
Affiliations: Yale University (US)
University of Virginia (US)
Université de Montréal (CA)
University of Rochester Medicine (US)
Hartford Hospital (US)
Cardiology Consultants, Calgary, Canada
Soundview Research Associates, Norwalk, Connecticut
MedStar Health Research Institute (US)
University of Alabama at Birmingham (US)
ORCID: Inzucchi, Silvio E.
Chyun, Deborah A.
Barrett, Eugene J.
Wittlin, Steven D.
Engel, Samuel
Venue: Diabetes Care
Publisher: American Diabetes Association
Published: 2004-08-01
Volume: 27
Issue: 8
Pages: 1954-1961
ISSN: 0149-5992 (ISSN-L)
1935-5548
DOI: 10.2337/diacare.27.8.1954
OpenAlex: W2159222156
Cited by: 791
References: 41
Citations by year: 2026: 5 · 2025: 12 · 2024: 6 · 2023: 13 · 2022: 15 · 2021: 20 · 2020: 23 · 2019: 28 · 2018: 30 · 2017: 34 · 2016: 34 · 2015: 35 · 2014: 46 · 2013: 51 · 2012: 42
FWCI: 50.56
Type: journal article
Language: en
Update notices: correction (2005-02-01)
Open access: bronze
doi.org
Locations: Diabetes Care (publishedVersion)
PubMed (publishedVersion)
Funders: Yale University
National Center for Research Resources (5-M01-RR-00044, M01RR000125, M01 RR-00125, 5 M01 RR00847, M01RR000044, M01RR000847, 5M01 RR0596)
Topics: Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords: silent myocardial ischemia, type 2 diabetes, asymptomatic patients, coronary artery disease, stress testing, myocardial perfusion imaging, 99mTc-sestamibi, cardiac autonomic dysfunction, Valsalva maneuver, ST-segment depression, diabetes duration, cardiovascular risk factors, prevalence
MeSH terms: Canada, Coronary Disease, Diabetes Mellitus, Type 1, Diabetic Angiopathies, Exercise Test, Female, Humans, Male, Middle Aged, Outpatients, United States, Tomography, Emission-Computed, Single-Photon, Myocardial Ischemia, Technetium Tc 99m Sestamibi, Radiopharmaceuticals

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Detection of Silent Myocardial Ischemia in Asymptomatic Diabetic Subjects

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