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European Heart Journal Advance Access published online on August 8, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi441
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received May 11, 2005
Revised June 30, 2005
Accepted July 13, 2005

Review

The role of non-invasive imaging in the risk stratification of asymptomatic diabetic subjects

Dhakshinamurthy Vijay Anand 1*, Eric Lim 2, Avijit Lahiri 2, and Jeroen J. Bax 3

1 Cardiac Imaging and Research Centre, Wellington Hospital (South Building), Wellington Road, St John's Wood, London NW8 9LE, UK; Department of Cardiology, Royal Free Hospital, London, UK
2 Cardiac Imaging and Research Centre, Wellington Hospital (South Building), Wellington Road, St John's Wood, London NW8 9LE, UK
3 Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

* To whom correspondence should be addressed.
Dhakshinamurthy Vijay Anand, E-mail: vdanand{at}hotmail.com


  Abstract

Aims Coronary artery disease (CAD) is the leading cause of death in patients with diabetes. Patients often present with advanced and asymptomatic disease. Proposed strategies that may favourably affect CAD risk and outcomes in this patient population include identifying diabetic patients with subclinical disease at high risk of future cardiac events. The purpose of this article was to review the role of both atherosclerosis imaging tests (coronary calcium imaging and high-resolution ultrasound assessment of carotid intima-media thickness) and functional imaging techniques [stress echocardiography and radionuclide myocardial perfusion imaging (MPI)] in the diagnostic and prognostic evaluation of asymptomatic diabetic subjects.

Methods and results We identified studies using MEDLINE searches (1966 to April 2005) and by reviewing reference lists. A comprehensive list of search terms was applied. All stress echocardiography and MPI studies evaluating the prevalence and/or prognostic value of myocardial ischaemia (n = 19) and coronary calcium imaging studies (n = 2) evaluating the prognostic value of subclinical atherosclerosis in diabetic patients were included.

Conclusion Asymptomatic myocardial ischaemia can be detected in a significant proportion of diabetic subjects by non-invasive imaging tests such as MPI and stress echocardiography. The results of ongoing and future studies may be helpful in guiding the selection of asymptomatic diabetic subjects to undergo non-invasive imaging, establishing the cost-effectiveness of various testing strategies and their impact on prognosis.

Keywords: Diabetes; Coronary artery disease; Atherosclerosis; Non-invasive imaging; Myocardial ischaemia; Coronary calcium.
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