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• W2103291610 abstract "Silent myocardial ischaemia (SMI), in which patients affected by coronary artery disease have a normal resting electrocardiogram (ECG) and no symptoms of angina, is predominant in diabetic people. The prevalence of SMI in diabetic patients is reported to be 7.6–12.6% (Koistinen 1990; Janand-Delenne et al. 1999; Gokcel et al. 2003; Fornengo et al. 2006). The aim of this study was to investigate the frequency of SMI in diabetic patients with retinopathy and to explore the risk factors for SMI in these patients. This prospective study was conducted between November 2006 and April 2009. All patients gave informed consent. We enrolled 165 patients with diabetic retinopathy who met the following criteria: (i) diabetes with retinopathy, (ii) age 75 years or less, (iii) a normal resting ECG and (iv) no symptoms of angina or any other clinical evidence of coronary artery disease (CAD). Those who met the inclusion criteria underwent screening for CAD, which included an exercise treadmill test (ETT), coronary computed tomography (CCT) and thallium myocardial scintigraphy (TMS). The patients who showed a positive response in the screening test underwent coronary angiography (CAG), and those who showed a positive result were diagnosed with CAD, that is, SMI. The clinical characteristics of the subjects are shown in Table 1. The worse eye was used for the evaluation, and the retinopathy was grouped into two categories: non-proliferative diabetic retinopathy and proliferative diabetic retinopathy (PDR). The estimated glomerular filtration rate (eGFR) was calculated using the following formula (Matsuo et al.2009): eGFR [ml/(min·1.73 m2)] = 194 × Cre−1.094 × Age−0.203 × 0.739 (if female). Statistical analysis was performed using spss for Windows (version 11.0; SPSS Chicago, IL, USA). p values 0.05 or less were regarded as statistically significant in this study. The performance of ETT was feasible in 147 patients, but the remaining 18 patients were considered ineligible for ETT because of severe visual deterioration, a diabetic foot ulcer and one-sided paralysis. ETT was judged negative in 95 patients, positive in 37 patients and non-diagnostic in 15 patients due to inadequate load because of blood pressure elevation and foot pain. A total of 33 patients underwent TMS or CCT. TMS was carried out in 13 patients, four of whom were revealed to have perfusion defects. CCT was performed in the remaining 20 patients, which revealed coronary artery stenoses in four patients. Thus, 45 patients were positive for the first screening test and proceeded to CAG. CAG revealed coronary artery stenoses in 37 patients, whereas the results of angiography were considered normal in the remaining patients. No complications occurred during the procedures. In short, 45 patients (27.3%) had a positive response for the screening test, and 37 patients (22.4%) were revealed to have SMI (Fig. 1). The positive predictive value of CAD in the screening test was 82.2% (37/45). Univariate analysis results showed that age (p = 0.050, chi-square test) and male (p = 0.025, Mann–Whitney U-test) had significance and that there were no significances on other factors such as body mass index (BMI), HbA1c, eGFR, insulin usage, type of diabetes and retinopathy severity. Result of multiple logistic regression analysis showed that age [Odds ratio (OR) = 1.06, 95% confidence interval (95% CI) = 1.02–1.10] and male (OR = 3.31, 95% CI = 1.22–8.99) were statistically significant risk factors for CAD. In this study, approximately 20% of diabetic patients with retinopathy were found to have accompanying subclinical CAD, which was ascertained by coronary angiography. Ophthalmologists should be aware of the high rate of this disease when examining these patients." @default.
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• W2103291610 date "2014-02-07" @default.
• W2103291610 modified "2023-10-16" @default.
• W2103291610 title "Silent myocardial ischaemia in patients with diabetic retinopathy" @default.
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• W2103291610 doi "https://doi.org/10.1111/aos.12362" @default.
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