Screening for heart disease in diabetic subjects

医学 亚临床感染 无症状的 心脏病学 内科学 冠状动脉疾病 心肌病 左心室肥大 糖尿病性心肌病 糖尿病 舒张期 疾病 心力衰竭 血压 内分泌学
作者
Zhi Fang,R. Schull-Meade,Rodel Leano,P. Mottram,Johannes B. Prins,Thomas H. Marwick
出处
期刊:American Heart Journal [Elsevier BV]
卷期号:149 (2): 349-354 被引量:122
标识
DOI:10.1016/j.ahj.2004.06.021
摘要

The prevalence of left ventricular hypertrophy (LVH), coronary artery disease, and subclinical cardiomyopathy in diabetic patients without known cardiac disease is unclear. We sought the frequency of these findings to determine whether plasma brain natriuretic peptide (BNP) could be used as an alternative screening tool to identify subclinical LV dysfunction. Asymptomatic patients with diabetes mellitus without known cardiac disease (n = 101) underwent clinical evaluation, measurement of BNP, exercise stress testing, and detailed echocardiographic assessment. After exclusion of overt dysfunction or ischemia, subclinical myocardial function was sought on the basis of myocardial systolic (Sm) and diastolic velocity (Em). Association was sought between subclinical dysfunction and clinical, biochemical, exercise, and echocardiographic variables. Of 101 patients, 22 had LVH and 16 had ischemia evidenced by exercise-induced wall motion abnormalities. Only 4 patients had abnormal BNP levels; BNP was significantly increased in patients with LVH. After exclusion of LVH and coronary artery disease, subclinical cardiomyopathy was identified in 24 of 66 patients. Subclinical disease could not be predicted by BNP. Even after exclusion of asymptomatic ischemia and hypertrophy, subclinical systolic and diastolic dysfunction occurs in a significant number of patients with type 2 diabetes. However, screening approaches, including BNP, do not appear to be sufficiently sensitive to identify subclinical dysfunction, which requires sophisticated echocardiographic analysis.
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