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- December 1, 2008 |
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"CVD in Type 2 Diabetes: Who and How to Investigate"Dr. Trisha O'Moore-Sullivan (biography)
English - 2007-03-03 - 39 minutes
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Summary :
In this presentation Dr. O'Moore-Sullivan talks about investigations that can be done in type 2 diabetic patients who are symptomatic for coronary artery disease (CAD), and some potential means of identifying high-risk asymptomatic patients.
Coronary angiography is the "gold standard" for the detection of coronary artery disease (CAD), whereas multi-slice computed tomography, electron beam computed tomography and magnetic resonance imaging are emerging anatomical tools for assessing CAD. SPECT nuclear imaging and the 2D stress echo are two available functional tests; Dr. O'Moore-Sullivan talks about their sensitivity and specificity in symptomatic diabetic patients, prognosis, and the warranty period of normal tests. Earlier this year there was a thorough review published by Bax et al. in Diabetes Care from the Global Dialogue Group for the Evaluation of Cardiovascular Risk in Patients with Diabetes, looking at the available imaging techniques in assessing CAD in symptomatic patients with diabetes (1).
The true prevalence of silent CAD in diabetic patients is unknown, however, in the DIAD (Detection of Ischemia in Asymptomatic Diabetics) study, about 20 percent of type 2 diabetic patients randomised to SPECT screening had an abnormal test (2). What is the role of coronary artery calcium (CAC) scoring in identifying higher-risk patients? In a study of 510 asymptomatic type 2 diabetic subjects it was found that "Subclinical atherosclerosis, measured by CAC imaging, is superior to the established cardiovascular risk factors for predicting silent myocardial ischaemia and short-term outcome. Further studies evaluating the impact of CAC imaging on clinical outcomes and its cost effectiveness are warranted." (3). In the same paper by Anand et al., a potential screening algorithm is suggested, that involves initial CAC imaging followed by selective myocardial perfusion imaging to identify high-risk asymptomatic type 2 diabetic patients.
Copyright © 2007 E-MedHosting.com Inc.
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Anatomical and functional tests for assessing CAD
- Imaging and prognosis in diabetic patients
- Data from the DIAD study: proportion of asymptomatic type 2 diabetic patients having an abnormal SPECT test
- The role of coronary artery calcium scoring in the identification of high-risk asymptomatic type 2 diabetic patients
Bibliographic references :
1. Bax JJ, Inzucchi SE, Bonow RO, Schuijf JD, Freeman MR, Barrett EJ; Global Dialogue Group for the Evaluation of Cardiovascular Risk in Patients with Diabetes.Cardiac Imaging for Risk Stratification in Diabetes Diabetes Care 30:1295-1304, 2007.
2. Wackers FJ, Young LH, Inzucchi SE, Chyun DA, Davey JA, Barrett EJ, Taillefer R, Wittlin SD, Heller GV, Filipchuk N, Engel S, Ratner RE, Iskandrian AE; Detection of Ischemia in Asymptomatic Diabetics Investigators.Detection of silent myocardial ischemia in asymptomatic diabetic subjects: the DIAD study. Diabetes Care 27:1954-1961, 2004.
3. Anand DV, Lim E, Hopkins D, Corder R, Shaw LJ, Sharp P, Lipkin D, Lahiri A. Risk stratification in uncomplicated type 2 diabetes: prospective evaluation of the combined use of coronary artery calcium imaging and selective myocardial perfusion scintigraphy Eur Heart J. 2006 Mar;27(6):713-21.
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