Page 105 - Petelin, Ana, Nejc Šarabon, Boštjan Žvanut, eds. 2017. Zdravje delovno aktivne populacije ▪︎ Health of the Working-Age Population. Proceedings. Koper: Založba Univerze na Primorskem/University of Primorska Press
P. 105
Prevalence of silent myocardial ischemia
in working-age patients with type 2 diabetes
mellitus
Alexander Kiško1, Marika Vereb2, Radoslav Dobránsky3, Marian Babčák1,
Lubica Derňarová1, Jan Kmec1, Jozef Leško4, František Neméth1,
Maria Marcinková5, Zuzana Farkašová1
1 University in Prešov, Faculty of Health Care; Cardiology Clinic, ProCare Prešov, Prešov,
Jurkovičova 19. 08001 Prešov, Slovak Republic.
2 Institute of Nuclear Medicine, Klinikum Kassel, Klinikum Kassel. D-34125 Kassel, Germany.
3 Diabetic & Metabolic Disorders Clinic, ProCare Prešov,
Jurkovičova 19. 08001 Prešov, Slovak Republic.
4 VIVAMED ltd, Nuclear Medicine, Hollého 14. 08181 Prešov, Slovak Republic.
5 Cardiology Clinic, ProCare Prešov, Jurkovičova 19. 08001 Prešov, Slovak Republic.
alexander.kisko@unipo.sk; mudr.marika.vereb.@gmail.com; dobranskyrado@gmail.com;
babcak@fnsppresov.sk; lubica.dernarova@unipo.sk; kmecj@fnsppresov.sk; lesko@vivamed.sk;
frantisek.nemeth@unipo.sk; marcinkova8@gmail.com; zuzana.farkasova@unipo.sk
Abstract
Introduction: Data confirm a relatively high prevalence of silent
myocardial ischemia (SMI) in elderly patients with type 2 diabetes
mellitus (T2DM), while no data are available regarding working-age
subjects (≤60 years). Methods: Medical records of 192 patients with
T2DM aged ≤60 years (110 male patients; 57.3%), who had undergone
myocardial perfusion imaging (MPI) between 2010 and 2014 followed by
coronary angiography in case of abnormal result, were retrospectively
analysed. Results: MPI was positive in 35 patients (18.2%); of those 31
(88.6%) had angiographically confirmed coronary stenosis. The positive
predictive value of the MPI for predicting angiographic coronary
stenosis in this age subgroup was 88.9%. Univariate analysis revealed
post-stress LVEF drop ≥5% (p<0.03) and NT-proBNP levels detected in
stress (p<0.05) to be associated with greater risk of ischemia in working-
age T2DM patients. In multivariate analysis, LVEF drop ≥5% (p< 0.03)
remained an independent predictor of SMI.
Conclusion: Prevalence of SMI in diabetic working-age patients was
similar to that observed in studies of subjects over 65 years-old. Post-
stress LVEF drop ≥5% and NT-proBNP levels can contribute to more
precise identification of SMI. Our data suggest that “aggressive”
management strategy should be implemented to reduce the risk of
cardiac events in T2DM patients of working-age.
Keywords: scintigraphy, silent myocardial ischemia, diabetes mellitus
doi: https://doi.org/10.26493/978-961-7023-32-9.103-111
in working-age patients with type 2 diabetes
mellitus
Alexander Kiško1, Marika Vereb2, Radoslav Dobránsky3, Marian Babčák1,
Lubica Derňarová1, Jan Kmec1, Jozef Leško4, František Neméth1,
Maria Marcinková5, Zuzana Farkašová1
1 University in Prešov, Faculty of Health Care; Cardiology Clinic, ProCare Prešov, Prešov,
Jurkovičova 19. 08001 Prešov, Slovak Republic.
2 Institute of Nuclear Medicine, Klinikum Kassel, Klinikum Kassel. D-34125 Kassel, Germany.
3 Diabetic & Metabolic Disorders Clinic, ProCare Prešov,
Jurkovičova 19. 08001 Prešov, Slovak Republic.
4 VIVAMED ltd, Nuclear Medicine, Hollého 14. 08181 Prešov, Slovak Republic.
5 Cardiology Clinic, ProCare Prešov, Jurkovičova 19. 08001 Prešov, Slovak Republic.
alexander.kisko@unipo.sk; mudr.marika.vereb.@gmail.com; dobranskyrado@gmail.com;
babcak@fnsppresov.sk; lubica.dernarova@unipo.sk; kmecj@fnsppresov.sk; lesko@vivamed.sk;
frantisek.nemeth@unipo.sk; marcinkova8@gmail.com; zuzana.farkasova@unipo.sk
Abstract
Introduction: Data confirm a relatively high prevalence of silent
myocardial ischemia (SMI) in elderly patients with type 2 diabetes
mellitus (T2DM), while no data are available regarding working-age
subjects (≤60 years). Methods: Medical records of 192 patients with
T2DM aged ≤60 years (110 male patients; 57.3%), who had undergone
myocardial perfusion imaging (MPI) between 2010 and 2014 followed by
coronary angiography in case of abnormal result, were retrospectively
analysed. Results: MPI was positive in 35 patients (18.2%); of those 31
(88.6%) had angiographically confirmed coronary stenosis. The positive
predictive value of the MPI for predicting angiographic coronary
stenosis in this age subgroup was 88.9%. Univariate analysis revealed
post-stress LVEF drop ≥5% (p<0.03) and NT-proBNP levels detected in
stress (p<0.05) to be associated with greater risk of ischemia in working-
age T2DM patients. In multivariate analysis, LVEF drop ≥5% (p< 0.03)
remained an independent predictor of SMI.
Conclusion: Prevalence of SMI in diabetic working-age patients was
similar to that observed in studies of subjects over 65 years-old. Post-
stress LVEF drop ≥5% and NT-proBNP levels can contribute to more
precise identification of SMI. Our data suggest that “aggressive”
management strategy should be implemented to reduce the risk of
cardiac events in T2DM patients of working-age.
Keywords: scintigraphy, silent myocardial ischemia, diabetes mellitus
doi: https://doi.org/10.26493/978-961-7023-32-9.103-111
