Patients with Type 1 diabetes mellitus have an increased risk of ischaemic heart disease (IHD). When diabetes is complicated by nephropathy this risk is further increased and asymptomatic IHD is common. New techniques for non-invasive cardiac evaluation are now available and one of these, Dobutamine Stress Echocardiography (DSE), was studied in subjects with Type 1 DM and nephropathy who had no evidence of IHD. DSE was performed on 18 subjects (13 male, 5 female; mean age 37.8 +/- 3.4 years), diabetes duration 23.7 +/- 1.2 years and nephropathy diagnosed for 10.9 +/- 1.3 years. There were 7 (38%) positive scans-suggesting asymptomatic IHD; 16.7% of subjects studied had a significant arrhythmia. Coronary angiography was performed in 6 of the 7 subjects with positive DSEs and was positive in only 2. These results suggest that DSE has a high rate of false positive results in Type 1 DM patients suffering from nephropathy and may limit its usefulness in these subjects.

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