Screening of Silent Myocardial Ischemia in Type 2 Diabetic Patients with Additional Atherogenic Risk Factors; The Applicability of Exercise Stress Test

Abstract

Background: Silent myocardial ischemia (SMI) is a major clinical entity. SMI is highly prevalent and occurs more commonly in patients with diabetes. It is a predictor of mortality. Objective: To assess SMIs in type 2 diabetic patients with atherogenic risk factors using exercise stress test (EST) and to evaluate its applicability as a screening test. Methods: The study was conducted on sixty-three type 2 diabetic symptomless patients (37 male, 26 female patients), and without resting electrocardiographic (ECG) signs of ischemia. Patients were divided into 2 groups; Group I: patients with one or none of the atherogenic risk factors and Group II: patients with 2 or more of the atherogenic risk factors or peripheral vascular disease (PVD) alone. EST was carried out for all patients. Ischemia was diagnosed by ECG. Other tests were carried out as echocardiography, ultrasound Doppler of carotid arteries. Results: Only 57/63 (90.5%) patients had a diagnostic EST; 11 (19.3%) tested to be positive and 46 (80.7%) tested to be negative. ECG indicated ischemic features in 10 patients with positive EST. Ultrasound Doppler showed PVD in 3 out of 41 patients. Using multivariate analysis, there was a significant association of positive EST with PVD, hyperlipidemia, smoking, and hypertension. Conclusion: As the number of the atherogenic risk factors in diabetic patients increase, the incidence of SMI increases. Therefore, EST is applicable and practicable for screening of SMI in type 2 diabetic patients with 2 or more atherogenic risk factors. Keywords: Silent Myocardial ischemia, Exercise Stress test, Diabetes mellitus. Citation: Al-Ethary ZY, Alrikabi MB. Screening of silent myocardial ischemia in type 2 diabetic patients with additional atherogenic risk factors; the applicability of exercise stress test. Iraqi JMS. 2020; 18(1): 70-78. doi: 10.22578/IJMS.18.1.10