Silent Myocardial Ischemia in Japanese Diabetes Patients

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  • 糖尿病患者における無症候性心筋虚血の頻度とその臨床的特徴，特に大動脈起始部-上腕脈波伝播速度の亢進について
  • トウニョウビョウ カンジャ ニ オケル ムショウコウセイ シンキンキョケツ ノ ヒンド ト ソノ リンショウテキ トクチョウ トクニ ダイドウミャクキシブ ジョウ ワン ミャクハ デンパ ソクド ノ コウシン ニ ツイテ

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Abstract

To clarify the actual state of silent myocardial ischemia (SMI) in patients with diabetes mellitus (DM) and to identify the risk factor (s), we examined the frequency of SMI and the clinical characteristics in outpatients with diabetes mellitus and SMI. We performed treadmill exercise testing electrocardiography (ECG) in 387 diabetic patients without anginal pain. We compared the history of the disease, physical status, pulse wave velocity and laboratory data in patients with a positive result of the exercise testing with those in patients with a negative result. Coronary angiography was performed in 92 patients with positive results in exercise testing. A positive result was observed in 20-25% of men over the age of 40 years and 25% of women over the age of 50 years. The duration of DM tended to be longer in the patients with positive results than those who tested negative. The systolic blood pressure was significantly higher in the patients testing positive, as was aortic-upper arm pulse wave velocity was in both males and females, compared with that in the patients tested negative. The upper arm-ankle pulse wave velocity increased in females tested positive. Multiple logistic analysis showed that systolic blood pressure and aortic-upper arm pulse wave velocity were independent risk factors in males. Coronary angiography showed significant stenosis in 66% of the patients with positive results. The stenoses were observed in multiple branches in more than 70% of these patients. The patients with stenosis had higher fasting plasma glucose and higher HbA1C levels, compared with those in the patients without stenosis. Prevalence of SMI in diabetes patients was estimated as 16%. Therefore, it seems that an ECG exercise testing should be performed for the diagnosis of SMI in diabetic patients in males over 40 years of age and in postmenopausal females with long duration of the disease, hypertension and/ or increased pulse wave velocity. Coronary angiography should be performed for definitive diagnosis of SMI in patients whose ECG exercise testing is positive, and who have poor glycemic control.

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