A novel and practical screening tool for the detection of silent myocardial infarction in patients with type 2 diabetes

Swoboda, P. P. and McDiarmid, A. K. and Erhayiem, B. and Haaf, P. and Kidambi, A. and Fent, G. J. and Dobson, L. E. and Musa, T. A. and Garg, P. and Law, G. R. and Kearney, M. T. and Barth, J. H. and Ajjan, R. and Greenwood, J. P. and Plein, S. (2016) A novel and practical screening tool for the detection of silent myocardial infarction in patients with type 2 diabetes. Journal of Clinical Endocrinology and Metabolism, 101 (9). pp. 3316-3323. ISSN 0021-972X

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Abstract

Silent myocardial infarction (MI) is a prevalent finding in patients with type 2 diabetes and is associated with significant mortality and morbidity. Late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR) is the most validated technique for detection of silent MI but is time consuming, costly and requires administration of intravenous contrast. We therefore planned to develop a simple and low cost population screening tool to identify those at highest risk of silent MI validated against the CMR reference standard.100 asymptomatic patients with type 2 diabetes underwent electrocardiogram (ECG), echocardiography, biomarker assessment and CMR at 3.0T including assessment of left ventricular ejection fraction and LGE. Global longitudinal strain (GLS) from 2 and 4 chamber cines was measured using feature tracking.17/100 patients with no history of cardiovascular disease had silent MI defined by LGE in an infarct pattern on CMR. Only 4 silent MI patients had Q waves on ECG. Patients with silent MI were older (65 vs 60, p=0.05), had lower E/A ratio (0.75 vs 0.89, p=0.004), lower GLS (-15.2% vs -17.7%, p=0.004) and higher NT-proBNP (106ng/L vs 52ng/L, p=0.003). A combined risk score derived from these 4 factors had an area under the receiver operating characteristic (ROC) curve of 0.823 (0.734-0.892), P<0.0001. A score of ?3/5 had 82% sensitivity and 72% specificity for silent MI.Using measures that can be derived in an outpatient clinic setting, we have developed a novel screening tool for the detection of silent MI in type 2 diabetes. The screening tool had significantly superior diagnostic accuracy than current ECG criteria for the detection of silent MI in asymptomatic patients.

Additional Information:© 2016 by the Endocrine Society. This is an author produced version of a paper published in Journal of Clinical Endocrinology and Metabolism. Uploaded in accordance with the publisher's self-archiving policy.
Keywords:Echocardiography, Diabetes mellitus type 2, Cardiac mri, Silent myocardial infarction, NotOAChecked
Subjects:B Subjects allied to Medicine > B100 Anatomy, Physiology and Pathology
Divisions:College of Social Science > School of Health & Social Care
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ID Code:26602
Deposited On:20 Apr 2017 09:07

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